Background
Long-term success of lung transplantation is limited by the development of chronic
lung allograft dysfunction (CLAD), of which bronchiolitis obliterans syndrome (BOS)
is the most common form. This systematic review sought to identify the current evidence
base for CLAD-BOS therapies after initial immunosuppressive treatment strategies.
Methods
The MEDLINE, Embase, and Cochrane Library databases from inception to May 3, 2016,
were searched using keywords relating to CLAD-BOS, study designs, and treatments of
interest, including extracorporeal photopheresis (ECP), aerosolized cyclosporine,
total lymphoid irradiation (TLI), alemtuzumab, and montelukast. Titles, abstracts,
and full texts were screened by 2 independent reviewers to identify studies of CLAD-BOS
second-line therapy in adult lung transplant patients. Quality was assessed according
to the Downs and Black checklist.
Results
Of the 936 individual citations identified, 47 reports of 40 studies met inclusion
criteria, including 17 full publications, 11 recent (2015–2016), and 12 older (pre-2015)
congress proceedings. Most of the full publications and recent abstracts investigated
ECP (n = 11), TLI (n = 5), alemtuzumab (n = 4), and montelukast (n = 2). Most studies were uncontrolled and retrospective. Compared with standard therapy
alone, improved lung function and survival was reported for ECP in 2 studies without
randomization, with lower-quality evidence for improved lung function for TLI, montelukast,
and aerosolized cyclosporine.
Conclusions
Because most identified studies were of retrospective and uncontrolled design, comparison
of treatment effects was limited. Available evidence suggests stabilized lung function
after ECP in combination with established immunosuppressive regimens in late-line
CLAD-BOS treatment, with fewer data for TLI, montelukast, and aerosolized cyclosporine.
Keywords
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Article info
Publication history
Published online: May 29, 2017
Identification
Copyright
© 2017 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.
