Abstract
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.
Keywords
bronchiectasis - allograft - chronic rejection - gram-negative rod infection - bronchiolitis
obliterans syndrome - lung transplantation
