Chest
Translating Basic Research into Clinical PracticeBronchiolitis Obliterans Syndrome: The Final Frontier for Lung Transplantation
Section snippets
Alloimmune T-Cell Reactivity
The rarity of BO in patients without transplantation emphasizes the fundamental role of alloimmune T-cell reactivity in the development of this condition. Acute cellular rejection is the most consistently described risk factor for BOS. Specifically, both acute vascular (A-grade) rejection, especially if histologically severe,7 and lymphocytic bronchiolitis (B-grade) rejection are associated with a significantly increased risk of BOS.8 Animal tracheal transplantation models demonstrate
Conclusions
BOS is the principal factor limiting long-term survival and quality of life after lung transplantation. Alloimmune reactivity plays a fundamental role in the development of BOS, and although T cells have been the traditional target of posttransplant immunosuppression, more potent T-cell-suppressing agents and innovative means of immunosuppressive drug delivery may further minimize the impact of the alloimmune response. Importantly, several exciting novel mechanisms, including antibody-mediated
Acknowledgments
Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
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