Longitudinal lung function measurements in single lung transplant recipients with chronic lung allograft dysfunction
Copyright © 2020 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved..
BACKGROUND: 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.
METHODS: 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).
RESULTS: 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; p < 0.001), 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.
CONCLUSIONS: 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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:39 |
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| Enthalten in: |
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation - 39(2020), 11 vom: 08. Nov., Seite 1270-1278 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Leuschner, Gabriela [VerfasserIn] |
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| Links: |
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| Themen: |
Bronchiolitis obliterans syndrome |
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| Anmerkungen: |
Date Completed 04.03.2022 Date Revised 04.03.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.healun.2020.08.008 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM314896465 |
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| 245 | 1 | 0 | |a Longitudinal lung function measurements in single lung transplant recipients with chronic lung allograft dysfunction |
| 264 | 1 | |c 2020 | |
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| 500 | |a Date Revised 04.03.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2020 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: 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 | ||
| 520 | |a METHODS: 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) | ||
| 520 | |a RESULTS: 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; p < 0.001), 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 | ||
| 520 | |a CONCLUSIONS: 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a bronchiolitis obliterans syndrome | |
| 650 | 4 | |a chronic lung allograft dysfunction | |
| 650 | 4 | |a chronic rejection | |
| 650 | 4 | |a lung function | |
| 650 | 4 | |a lung transplantation | |
| 650 | 4 | |a restrictive allograft syndrome | |
| 700 | 1 | |a Lauseker, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Howanietz, Anne-Sophie |e verfasserin |4 aut | |
| 700 | 1 | |a Milger, Katrin |e verfasserin |4 aut | |
| 700 | 1 | |a Veit, Tobias |e verfasserin |4 aut | |
| 700 | 1 | |a Munker, Dieter |e verfasserin |4 aut | |
| 700 | 1 | |a Schneider, Christian |e verfasserin |4 aut | |
| 700 | 1 | |a Weig, Thomas |e verfasserin |4 aut | |
| 700 | 1 | |a Michel, Sebastian |e verfasserin |4 aut | |
| 700 | 1 | |a Barton, Jürgen |e verfasserin |4 aut | |
| 700 | 1 | |a Meiser, Bruno |e verfasserin |4 aut | |
| 700 | 1 | |a Dinkel, Julien |e verfasserin |4 aut | |
| 700 | 1 | |a Neurohr, Claus |e verfasserin |4 aut | |
| 700 | 1 | |a Behr, Jürgen |e verfasserin |4 aut | |
| 700 | 1 | |a Kneidinger, Nikolaus |e verfasserin |4 aut | |
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