BACKGROUND:Bronchiolitis obliterans syndrome (BOS) after lung transplantation manifests as a gradual decline in forced expiratory volume in 1 second. Bronchiectasis is often seen but occurs at variable rates with the underlying pathogenesis being unclear. OBJECTIVE:We completed a study to determine whether lower airway infection with gram-negative bacilli was associated with the development of bronchiectasis in lung transplant recipients with BOS. METHODS:A retrospective review of 17 lung transplant recipients (age: 28 ± 7 years, range: 13 to 40 years) in a patient population transplanted for cystic fibrosis (CF) 82% (14/17), bronchiolitis obliterans 12% (2/17), and sarcoidosis 6% (1/17) was completed. Each patient completed pulmonary function testing and underwent annual computed tomographic imaging of the chest for surveillance posttransplant at a single transplant center. RESULTS:Bronchiectasis was present in 70% (12/17) of patients whereas 94% (16/17) of patients had varying severity of BOS: 1 (n = 7), 2 (n = 3), and 3 (n = 6). All 12 patients with bronchiectasis had an allograft gram-negative rod infection and 92% (11/12) of them had BOS. CONCLUSIONS:The presence of bronchiectasis in lung transplant recipients with BOS was associated with a gram-negative bacterial airway infection of the allograft in a small cohort of predominately lung transplant recipients with CF.

译文

背景:肺移植后闭塞性细支气管炎综合征(BOS)表现为强迫呼气量在1秒内逐渐下降。支气管扩张常见,但发生率可变,其潜在发病机制尚不清楚。
目的:我们完成了一项研究,以确定在接受BOS的肺移植受者中,革兰氏阴性细菌的下呼吸道感染是否与支气管扩张有关。
方法:回顾性分析17例肺移植受者(年龄:28±7岁,范围:13至40岁),该患者群体因囊性纤维化(CF)移植了82%(14/17),闭塞性细支气管炎12%(2 / 17),结节病6%(1/17)完成了。每位患者均完成了肺功能测试,并在单个移植中心接受了每年的胸部X线计算机断层扫描成像,以监测移植后的情况。
结果:70%(12/17)的患者存在支气管扩张,而94%(16/17)的BOS严重程度各不相同:1(n = 7),2(n = 3)和3(n = 6)。所有12例支气管扩张患者均具有同种异体革兰氏阴性杆感染,其中92%(11/12)患有BOS。
结论:BOS肺移植受者中支气管扩张的存在与同种异体移植物的革兰氏阴性细菌气道感染有关,这是一小部分以CF为主的肺移植受者。

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