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Ann Thorac Surg 1995;60:1346-1347
© 1995 The Society of Thoracic Surgeons

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Discussion

Discussion

The first 300 words of the full text of this article appear below.

See also page 1341.

DR THOMAS M. EGAN (Chapel Hill, NC): I congratulate Dr Sundaresan for a very concise presentation, which represents an extensive audit of their program to establish the incidence and prevalence of posttransplantation bronchiolitis obliterans syndrome, or BOS. They have brought to our attention the alarming frequency of development of this complication, and they have also emphasized the heterogeneity of this clinical syndrome.

Our data at the University of North Carolina are similar. Among 72 lung transplant recipients surviving longer than 3 months who are at risk, the distribution of prevalence is 39 patients in whom BOS has not developed and 33 patients in whom BOS or biopsy-proven obliterative bronchiolitis has developed. There are 3 patients in grade 1, 8 in grade 2, and 15 in grade 3; 14 of the 33 patients with BOS have died.

Rather than assess these data by quartile, we have calculated the actuarial freedom from BOS, and I believe that the current report would be strengthened by inclusion of this analysis. This depicts the time course to development of BOS, and it is clear that in most patients, BOS will begin to develop between 6 and 30 months. A good study raises additional questions, and this one is no exception. This study clearly begs the question, why do so many patients have development of BOS? Perhaps the better query is why BOS does not develop in some patients.

I have several questions for Dr Sundaresan. Have you performed any multivariate analyses to identify risk factors for the development of BOS? Although you have noted a higher risk of mortality among patients with BOS, how many of your BOS patients remained stable and what is the incidence of progression from grade 1 to 2, from 2 to 3, and so on? Could . . . [Full Text of this Article]

Related Article

Prevalence and Outcome of Bronchiolitis Obliterans Syndrome After Lung Transplantation

Sudhir Sundaresan, Elbert P. Trulock, Thallachallour Mohanakumar, Joel D. Cooper, and G. Alexander Patterson
Ann. Thorac. Surg. 1995 60: 1341-1346. [Abstract] [Full Text]