Therapeutic options for bronchiolitis obliterans syndrome after lung transplantation

The development of chronic lung allograft dysfunction (CLAD) is one of the major obstacles following lung transplantation and limits patients’ long-term outcome. Within the group of emerging CLAD phenotypes, bronchiolitis obliterans syndrome is the most common form and observed in up to 75% of lung transplant recipients 10 years after transplantation. Therapeutic options to address BOS are limited and, at our center, include modification of immunosuppression, immunomodulation using macrolide antibiotics, the use of statins, leukotriene receptor antagonists, and extracorporeal photopheresis. The evidence for most of these therapy options is derived from case reports or small, descriptive studies, whereas controlled trials are yet to be conducted. In the context of an illustrative case report, we review hereby the current literature regarding these different treatment options.