Abstract
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 {\textless} 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.
Item Type: | Journal article |
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Faculties: | Medicine > Institute for Medical Information Processing, Biometry and Epidemiology |
Subjects: | 600 Technology > 610 Medicine and health |
Language: | English |
Item ID: | 73689 |
Date Deposited: | 14. Oct 2020, 08:24 |
Last Modified: | 26. Aug 2022, 08:42 |