Abstract | RATIONALE: OBJECTIVES: To determine if the influence of pseudomonas isolation and ELR(+) CXC chemokines on the subsequent development of BOS and the occurrence of death is time dependent. METHODS: A three-state model was developed to assess the likelihood of transitioning from lung transplant (state 1) to BOS (state 2), from transplant (state 1) to death (state 3), and from BOS (state 2) to death (state 3). This Cox semi-Markovian approach determines state survival rates and cause-specific hazards for movement from one state to another. MEASUREMENTS AND MAIN RESULTS: The likelihood of transition from transplant to BOS was increased by acute rejection, CXCL5, and the interaction between pseudomonas and CXCL1. The pseudomonas effect in this transition was due to infection rather than colonization. Movement from transplant to death was facilitated by pseudomonas infection and single lung transplant. Transition from BOS to death was affected by the length of time in state 1 and by the interactions between any pseudomonas isolation and CXCL5 and aspergillus, either independently or in combination. CONCLUSIONS: Our model demonstrates that common post- transplantation events drive movement from one post- transplantation state to another and influence outcomes differently depending upon when after transplantation they occur. Pseudomonas and the ELR(+) CXC chemokines may interact to negatively influence lung transplant outcomes.
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Authors | Aric L Gregson, Xiaoyan Wang, S Sam Weigt, Vyacheslav Palchevskiy, Joseph P Lynch 3rd, David J Ross, Bernard M Kubak, Rajan Saggar, Michael C Fishbein, Abbas Ardehali, Gang Li, Robert Elashoff, John A Belperio |
Journal | American journal of respiratory and critical care medicine
(Am J Respir Crit Care Med)
Vol. 187
Issue 5
Pg. 518-26
(Mar 01 2013)
ISSN: 1535-4970 [Electronic] United States |
PMID | 23328531
(Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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Chemical References |
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Topics |
- Bronchiolitis Obliterans
(epidemiology, immunology, microbiology)
- Bronchoalveolar Lavage Fluid
(immunology, microbiology)
- Carrier State
(epidemiology)
- Chemokines, CXC
(metabolism)
- Follow-Up Studies
- Humans
- Immunohistochemistry
- Los Angeles
(epidemiology)
- Lung Transplantation
(mortality)
- Markov Chains
- Prognosis
- Proportional Hazards Models
- Pseudomonas Infections
(epidemiology)
- Pseudomonas aeruginosa
- Risk Factors
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