Bronchiolitis obliterans in patients undergoing allogeneic hematopoietic SCT.

Bronchiolitis obliterans (BO) is a severe pulmonary complication of allo-SCT. This study evaluated the incidence of BO in patients undergoing allo-SCT in Hospital Universitário da Universidade Federal do Paraná, risk factors for developing this complication and prognostic factors for those patients who developed this entity. The study included 1286 patients transplanted between 1979 and 2009 who survived for 100 days or more. We diagnosed 53 cases of BO. The cumulative incidence was 2.9% in 1 year and 3.7% in 3 years. Among patients with chronic GVHD, the cumulative incidence at the same intervals was 8.4% and 9.9%, respectively. The median time between transplantation and diagnosis of BO was 260 days (49-3877 days). In the multivariate analysis the risk factors for BO were female donor, older recipients and acute GVHD. The main prognostic factor was the severity of pulmonary impairment. Patients who developed BO earlier than 260 days had a worse prognosis than those who did so later. At least 80% of deaths were directly related to BO.

Bronchiolitis obliterans syndrome development in lung transplantation patients.

UNLABELLED: The main cause of death in lung transplantation patients is chronic rejection, known as bronchiolitis obliterans syndrome (BOS). There are many variables associated with its appearance. The aim of this study was to identify factors associated with BOS and its impact on survival among lung transplantation patients. METHODS: We retrospectively analyzed charts of lung transplant patients from 1999 to 2009, evaluating survival, BOS, and associated factors. RESULTS: Fifty-six patients have been transplanted with a 5-year survival of 55%. Eighteen (32%) developed BOS, at a mean age at diagnosis of 57 years (range 16-74). According to BOS classification, seven patients (38.8%) were type 2 and six (33.3%) type 3. Half the patients developed BOS at a mean of 8.5 months after transplantation with a mean survival of 18.5 months (range 2-61). Among the factors analyzed, 13 patients (72%) displayed acute cellular rejection and nine (50%) gastroesophageal reflux disease (GERD) diagnosed by pHmetry, both of which were significantly associated with BOS (P = .005). Among seven lung transplantation patients with invasive cytomegalovirus disease, the four who developed BOS (P = .04) showed the worst survival (P = .05). Four of the six patients with severe BOS (66.6%) died at a mean of 10.6 months after the diagnosis. The main cause of death was respiratory insufficiency. CONCLUSIONS: BOS was associated with worse survival. The presence of acute cellular rejection episodes, CMV disease, and GERD were factors associated with chronic lung rejection.

Lower respiratory infections by adenovirus in children. Clinical features and risk factors for bronchiolitis obliterans and mortality.

UNLABELLED: Adenovirus (Ad) respiratory infections have a profound impact in Argentina. Severe chronic disease and a high mortality rate are observed in children after acute lower respiratory infections (ALRI) by Ad. METHODS: A retrospective observational study was performed to describe clinical characteristics and to analyze risk factors for bronchiolitis obliterans (BO) and death in 415 children hospitalized with ALRI caused by Ad from March 1988 to May 2005. RESULTS: Mean age of patients was 10.7 months (+/-9.2) Overall 80% of patients were healthy before ALRI. Forty-nine percent recovered, sequelae were observed in 36% and 15% died. Independent risk factors for BO were: >30 days of hospitalization (odds ratio (OR) 27.2, 95% confidence interval (CI) 14.6-50.9), multifocal pneumonia (OR 26.6, 95% CI 5.3-132) and hypercapnia (OR 5.6, 95% CI 3.5-9). Independent risk factors for death in acute stage of disease were: mechanical assistance (OR 121, 95% CI 18.2-814), multifocal pneumonia (OR 102, 95% CI 9.5-31.1), hypercapnia (OR 42.6, 95% CI 10.2-177.1), coagulation disorders (OR 17, 95% CI 8.25-35), neurological symptoms (OR 12.7, 95% CI 3.5-6.6) and co-infection with measles (OR 9.6, 95% CI 2.1-44.2). CONCLUSIONS: High incidence of sequelae and mortality in previously healthy children after Ad infection was observed in a population of children from Argentina.