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Phenotypical diversity of airway morphology in chronic lung graft vs. host disease after stem cell transplantation

(2019) MODERN PATHOLOGY. 32(6). p.817-829
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Abstract
Pulmonary graft vs. host disease is a diverse and underestimated complication following allogenic hematopoietic stem cell transplantation. We aimed to compare the airway architecture with chronic lung allograft dysfunction post lung transplantation. Inflated explant lungs from graft vs. host disease patients were compared with lungs with chronic lung allograft dysfunction following lung transplantation, and control lungs using a combination of CT, microCT, and histology (n = 6 per group) and pathology in the (small) airways was further quantified and analyzed. Following allogenic hematopoietic stem cell transplantation, three patients presented as bronchiolitis obliterans syndrome and three patients showed interstitial changes and restriction. The CT analysis demonstrated a strong similarity between bronchiolitis obliterans syndrome after lung transplantation and post allogenic hematopoietic stem cell transplantation, evidenced by severe (> 50%) airway obstruction from generation 9, with 70.8% of the airways ending in obstruction. Further analysis indicated that the airways either collapsed or accumulated matrix along a segment of the airway. In patients with restriction and interstitial changes following allogenic hematopoietic stem cell transplantation, the degree of airway obstruction was lower compared with bronchiolitis obliterans syndrome post allogenic hematopoietic stem cell transplantation, but similar to restrictive allograft syndrome post lung transplantation, showing a lower proportion of airway obstruction (20-35%), decreased number of terminal bronchioles per lung (p < 0.01), and parenchymal fibrosis. We observed similarities in the airway and parenchymal morphometric changes in lung graft vs. host disease and with chronic lung allograft dysfunction following lung transplantation, suggesting similar pathophysiological mechanisms.
Keywords
BRONCHIOLITIS OBLITERANS SYNDROME, PLEUROPARENCHYMAL FIBROELASTOSIS, ALLOGRAFT DYSFUNCTION, SURVIVAL, MORTALITY

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MLA
Verleden, Stijn E., et al. “Phenotypical Diversity of Airway Morphology in Chronic Lung Graft vs. Host Disease after Stem Cell Transplantation.” MODERN PATHOLOGY, vol. 32, no. 6, 2019, pp. 817–29.
APA
Verleden, S. E., McDonough, J. E., Schoemans, H., Knoop, C., Verschakelen, J., Dubbeldam, A., … Vanaudenaerde, B. M. (2019). Phenotypical diversity of airway morphology in chronic lung graft vs. host disease after stem cell transplantation. MODERN PATHOLOGY, 32(6), 817–829.
Chicago author-date
Verleden, Stijn E, John E McDonough, Helene Schoemans, Christiane Knoop, Johny Verschakelen, Adriana Dubbeldam, Matthieu Boone, et al. 2019. “Phenotypical Diversity of Airway Morphology in Chronic Lung Graft vs. Host Disease after Stem Cell Transplantation.” MODERN PATHOLOGY 32 (6): 817–29.
Chicago author-date (all authors)
Verleden, Stijn E, John E McDonough, Helene Schoemans, Christiane Knoop, Johny Verschakelen, Adriana Dubbeldam, Matthieu Boone, Luc Van Hoorebeke, Erik Verbeken, Birgit Weynand, Dirk Van Raemdonck, Geert M Verleden, Robin Vos, and Bart M Vanaudenaerde. 2019. “Phenotypical Diversity of Airway Morphology in Chronic Lung Graft vs. Host Disease after Stem Cell Transplantation.” MODERN PATHOLOGY 32 (6): 817–829.
Vancouver
1.
Verleden SE, McDonough JE, Schoemans H, Knoop C, Verschakelen J, Dubbeldam A, et al. Phenotypical diversity of airway morphology in chronic lung graft vs. host disease after stem cell transplantation. MODERN PATHOLOGY. 2019;32(6):817–29.
IEEE
[1]
S. E. Verleden et al., “Phenotypical diversity of airway morphology in chronic lung graft vs. host disease after stem cell transplantation,” MODERN PATHOLOGY, vol. 32, no. 6, pp. 817–829, 2019.
@article{8602911,
  abstract     = {Pulmonary graft vs. host disease is a diverse and underestimated complication following allogenic hematopoietic stem cell transplantation. We aimed to compare the airway architecture with chronic lung allograft dysfunction post lung transplantation. Inflated explant lungs from graft vs. host disease patients were compared with lungs with chronic lung allograft dysfunction following lung transplantation, and control lungs using a combination of CT, microCT, and histology (n = 6 per group) and pathology in the (small) airways was further quantified and analyzed. Following allogenic hematopoietic stem cell transplantation, three patients presented as bronchiolitis obliterans syndrome and three patients showed interstitial changes and restriction. The CT analysis demonstrated a strong similarity between bronchiolitis obliterans syndrome after lung transplantation and post allogenic hematopoietic stem cell transplantation, evidenced by severe (> 50%) airway obstruction from generation 9, with 70.8% of the airways ending in obstruction. Further analysis indicated that the airways either collapsed or accumulated matrix along a segment of the airway. In patients with restriction and interstitial changes following allogenic hematopoietic stem cell transplantation, the degree of airway obstruction was lower compared with bronchiolitis obliterans syndrome post allogenic hematopoietic stem cell transplantation, but similar to restrictive allograft syndrome post lung transplantation, showing a lower proportion of airway obstruction (20-35%), decreased number of terminal bronchioles per lung (p < 0.01), and parenchymal fibrosis. We observed similarities in the airway and parenchymal morphometric changes in lung graft vs. host disease and with chronic lung allograft dysfunction following lung transplantation, suggesting similar pathophysiological mechanisms.},
  author       = {Verleden, Stijn E and McDonough, John E and Schoemans, Helene and Knoop, Christiane and Verschakelen, Johny and Dubbeldam, Adriana and Boone, Matthieu and Van Hoorebeke, Luc and Verbeken, Erik and Weynand, Birgit and Van Raemdonck, Dirk and Verleden, Geert M and Vos, Robin and Vanaudenaerde, Bart M},
  issn         = {0893-3952},
  journal      = {MODERN PATHOLOGY},
  keywords     = {BRONCHIOLITIS OBLITERANS SYNDROME,PLEUROPARENCHYMAL FIBROELASTOSIS,ALLOGRAFT DYSFUNCTION,SURVIVAL,MORTALITY},
  language     = {eng},
  number       = {6},
  pages        = {817--829},
  title        = {Phenotypical diversity of airway morphology in chronic lung graft vs. host disease after stem cell transplantation},
  url          = {http://dx.doi.org/10.1038/s41379-019-0203-2},
  volume       = {32},
  year         = {2019},
}

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