Bronchiolitis Obliterans Syndrome Complicating Lung or Heart-Lung Transplantation

John A. Belperio, MD; Kathleen Lake, PharmD; Henry Tazelaar, MD; Michael P. Keane, MD; Robert M. Strieter, MD; Joseph P. Lynch, III, MD


Semin Respir Crit Care Med. 2003;24(5) 

In This Article

Bronchiolitis Obliterans-Organizing Pneumonia

Bronchiolitis obliterans-organizing pneumonia (BOOP) has been noted in both lung and heart-lung transplant recipients.[7,10,28,29] Histological features include fibromyxomatous granulation tissue filling bronchioles and extending into alveolar ducts and alveoli[28] (Fig. 3). Although early reports of BOOP in LTRs were often associated with infection,[7,28] BOOP may represent a form of allograft rejection and may progress to BO.[10] In one review, histological features of BOOP were found in 17 of 163 (10%) LTRs; AR was present concurrently in 11 (65%).[10] Ten of the 17 patients (59%) developed BO.[10] In one study, BOOP was observed in at least one biopsy in 78 (34%) LTRs[9] and was associated with increased risk of developing BOS (H.R. [hazard ratio] of 1.75)

Bronchiolitis obliterans organizing pneumonia in a lung transplant recipient (transbronchial biopsy). There is intra-airway organization that extends from the lumen of a terminal bronchiole (*) into an adjacent respiratory bronchiole. Hematoxylin-eosin, high power.


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