Course of FEV(1) after onset of bronchiolitis obliterans syndrome in lung transplant recipients.

Abstract

RATIONALE:

Bronchiolitis obliterans syndrome (BOS), defined by loss of lung function, develops in the majority of lung transplant recipients. However, there is a paucity of information on the subsequent course of lung function in these patients.

OBJECTIVES:

To characterize the course of FEV(1) over time after development of BOS and to determine the predictors that influence the rate of functional decline of FEV(1).

METHODS:

FEV(1)% predicted (FEV(1)%pred) trajectories were studied in 111 lung transplant recipients with BOS by multivariate, linear, mixed-effects statistical models.

MEASUREMENTS AND MAIN RESULTS:

FEV(1)%pred varied over time after BOS onset, with the steepest decline typically seen in the first 6 months (12% decline; p < 0.0001). Bilateral lung transplant recipients had significantly higher FEV(1)%pred at BOS diagnosis (71 vs. 47%; p < 0.0001) and at 24 months after BOS onset (58 vs. 41%; p = 0.0001). Female gender and pretransplant diagnosis of idiopathic pulmonary fibrosis were associated with a steeper decline in FEV(1)%pred in the first 6 months after BOS diagnosis (p = 0.02 and 0.04, respectively). A fall in FEV(1) greater than 20% in the 6 months preceding BOS (termed "rapid onset") was associated with shorter time to BOS onset (p = 0.01), lower FEV(1)%pred at BOS onset (p < 0.0001), steeper decline in the first 6 months (p = 0.03), and lower FEV(1)%pred at 2 years after onset (p = 0.0002).

CONCLUSIONS:

Rapid onset of BOS, female gender, pretransplant diagnosis of idiopathic pulmonary fibrosis, and single-lung transplantation are associated with worse pulmonary function after BOS onset.

• Authors: Vibha N Lama, Susan Murray, Robert J Lonigro, Galen B Toews, Andrew Chang, Christine Lau, Andrew Flint, Kevin M Chan, Fernando J Martinez
• Journal: American journal of respiratory and critical care medicine (Am J Respir Crit Care Med) Vol. 175 Issue 11 Pg. 1192-8 (Jun 01 2007) ISSN: 1073-449X [Print] United States
• PMID: 17347496 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Biopsy
• Bronchi (pathology)
• Bronchiolitis Obliterans (etiology, pathology, physiopathology)
• Diagnosis, Differential
• Disease Progression
• Female
• Follow-Up Studies
• Forced Expiratory Volume (physiology)
• Humans
• Hypertension, Pulmonary (surgery)
• Lung Transplantation (adverse effects)
• Male
• Middle Aged
• Postoperative Complications
• Prognosis
• Pulmonary Emphysema (surgery)
• Retrospective Studies
• Severity of Illness Index
• Syndrome
• Time Factors