Longitudinal lung function measurements in single lung transplant recipients with chronic lung allograft dysfunction
| Autor: | Anne-Sophie Howanietz, Katrin Milger, Sebastian Michel, Jürgen Behr, Thomas Weig, Christian Schneider, Bruno Meiser, Julien Dinkel, Nikolaus Kneidinger, Dieter Munker, Gabriela Leuschner, Michael Lauseker, Jürgen Barton, Claus Neurohr, Tobias Veit |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine Spirometry medicine.medical_specialty medicine.medical_treatment Respiratory physiology 030230 surgery Gastroenterology Pulmonary function testing 03 medical and health sciences 0302 clinical medicine Risk Factors Germany Internal medicine Humans Medicine Lung transplantation Lung volumes Lung function Retrospective Studies Transplantation Lung medicine.diagnostic_test business.industry Incidence Hazard ratio Middle Aged respiratory system Allografts Prognosis Transplant Recipients Survival Rate medicine.anatomical_structure 030228 respiratory system Chronic Disease Female Surgery Primary Graft Dysfunction Cardiology and Cardiovascular Medicine business Follow-Up Studies Lung Transplantation |
| Zdroj: | The Journal of Heart and Lung Transplantation. 39:1270-1278 |
| ISSN: | 1053-2498 |
| Popis: | Phenotyping chronic lung allograft dysfunction (CLAD) in single lung transplant (SLTX) recipients is challenging. The aim of this study was to assess the diagnostic and prognostic value of longitudinal lung function tests in SLTX recipients with CLAD.A total of 295 SLTX recipients were analyzed and stratified according to native lung physiology. In addition to spirometry, measurements of static lung volumes and lung capacities were used to phenotype patients and to assess their prognostic value. Outcome was survival after CLAD onset. Patients with insufficient clinical information were excluded (n = 71).Of 224 lung transplant recipients, 105 (46.9%) developed CLAD. Time to CLAD onset (hazard ratio [HR]: 0.82, 95% CI: 0.74-0.90; p0.001), severity of CLAD at onset (HR: 0.97, 95% CI: 0.94-0.99; p = 0.009), and progression after onset of CLAD (HR: 1.03, 95% CI: 1.00-1.05; p = 0.023) were associated with outcome. Phenotypes at onset were bronchiolitis obliterans syndrome (BOS) (59.1%), restrictive allograft syndrome (RAS) (12.4%), mixed phenotype (6.7%), and undefined phenotype (21.9%). Survival estimates differed significantly between phenotypes (p = 0.004), with RAS and mixed phenotype being associated with the worst survival, followed by BOS and undefined phenotype. Finally, a higher hazard for mortality was noticed for RAS (HR: 2.34, 95% CI: 0.99-5.52; p = 0.054) and mixed phenotype (HR: 3.30, 95% CI: 1.20-9.11; p = 0.021) while controlling for time to CLAD onset and severity of CLAD at onset.Phenotyping CLAD in SLTX remains challenging with a high number of patients with an undefined phenotype despite comprehensive lung function testing. However, phenotyping is of prognostic value. Furthermore, early, severe, and progressive CLADs are associated with worse survival. |
| Databáze: | OpenAIRE |
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