Characterization of Baseline Lung Allograft Dysfunction in Single Lung Transplant Recipients.
Journal
Transplantation
ISSN: 1534-6080
Titre abrégé: Transplantation
Pays: United States
ID NLM: 0132144
Informations de publication
Date de publication:
09 Sep 2024
09 Sep 2024
Historique:
medline:
9
9
2024
pubmed:
9
9
2024
entrez:
9
9
2024
Statut:
aheadofprint
Résumé
Baseline lung allograft dysfunction (BLAD) is characterized by the failure to achieve normal baseline lung function after double lung transplantation (DLTX) and is associated with a high risk of mortality. In single lung transplant (SLTX) recipients, however, cutoff values and associated factors have not been explored. Here, we aimed to define BLAD in SLTX recipients, investigate its impact on allograft survival, and identify potential risk factors for BLAD in SLTX recipients. We performed a retrospective, single-center analysis of the LTX cohort of LMU Munich between 2010 and 2018. In accordance with DLTX cutoffs, BLAD in SLTX recipients was defined as failure to achieve percentage of forced expiratory volume in 1 s and percentage of forced vital capacity of >60% on 2 consecutive tests >3 wk apart. Survival analysis and regression analysis for potential predictors of BLAD were performed. In a cohort of 141 SLTX recipients, 43% of patients met BLAD criteria. SLTX recipients with BLAD demonstrated impaired survival. Native lung hyperinflation was associated with BLAD in obstructive disease, whereas donor/recipient lung size mismatch was associated with BLAD in both obstructive and restrictive underlying diseases. Pulmonary function testing at 3 mo after lung transplantation predicted normal baseline lung function in SLTX recipients with obstructive lung disease. BLAD in SLTX recipients is as relevant as in DLTX recipients and should generally be considered in the follow-up of LTX recipients. Risk factors for BLAD differed between underlying obstructive and restrictive lung disease. A better understanding of associated factors may help in the development of preventive strategies.
Sections du résumé
BACKGROUND
BACKGROUND
Baseline lung allograft dysfunction (BLAD) is characterized by the failure to achieve normal baseline lung function after double lung transplantation (DLTX) and is associated with a high risk of mortality. In single lung transplant (SLTX) recipients, however, cutoff values and associated factors have not been explored. Here, we aimed to define BLAD in SLTX recipients, investigate its impact on allograft survival, and identify potential risk factors for BLAD in SLTX recipients.
METHODS
METHODS
We performed a retrospective, single-center analysis of the LTX cohort of LMU Munich between 2010 and 2018. In accordance with DLTX cutoffs, BLAD in SLTX recipients was defined as failure to achieve percentage of forced expiratory volume in 1 s and percentage of forced vital capacity of >60% on 2 consecutive tests >3 wk apart. Survival analysis and regression analysis for potential predictors of BLAD were performed.
RESULTS
RESULTS
In a cohort of 141 SLTX recipients, 43% of patients met BLAD criteria. SLTX recipients with BLAD demonstrated impaired survival. Native lung hyperinflation was associated with BLAD in obstructive disease, whereas donor/recipient lung size mismatch was associated with BLAD in both obstructive and restrictive underlying diseases. Pulmonary function testing at 3 mo after lung transplantation predicted normal baseline lung function in SLTX recipients with obstructive lung disease.
CONCLUSIONS
CONCLUSIONS
BLAD in SLTX recipients is as relevant as in DLTX recipients and should generally be considered in the follow-up of LTX recipients. Risk factors for BLAD differed between underlying obstructive and restrictive lung disease. A better understanding of associated factors may help in the development of preventive strategies.
Identifiants
pubmed: 39250332
doi: 10.1097/TP.0000000000005189
pii: 00007890-990000000-00868
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
This work was supported by the German Center of Lung Research (DZL). The other authors declare no conflict of interest.
Références
Verleden GM, Gottlieb J. Lung transplantation for COPD/pulmonary emphysema. Eur Respir Rev. 2023;32:220116.
Neurohr C, Huppmann P, Thum D, et al.; Munich Lung Transplant Group. Potential functional and survival benefit of double over single lung transplantation for selected patients with idiopathic pulmonary fibrosis. Transpl Int. 2010;23:887–896.
Thabut G, Christie JD, Ravaud P, et al. Survival after bilateral versus single lung transplantation for patients with chronic obstructive pulmonary disease: a retrospective analysis of registry data. Lancet. 2008;371:744–751.
Puri V, Patterson GA, Meyers BF. Single versus bilateral lung transplantation: do guidelines exist? Thorac Surg Clin. 2015;25:47–54.
Mason DP, Rajeswaran J, Li L, et al. Effect of changes in postoperative spirometry on survival after lung transplantation. J Thorac Cardiovasc Surg. 2012;144:197–203.
Mason DP, Rajeswaran J, Murthy SC, et al. Spirometry after transplantation: how much better are two lungs than one? Ann Thorac Surg. 2008;85:1193–201, 1201.e1.
Gerbase MW, Spiliopoulos A, Rochat T, et al. Health-related quality of life following single or bilateral lung transplantation: a 7-year comparison to functional outcome. Chest. 2005;128:1371–1378.
Quanjer PH, Stanojevic S, Cole TJ, et al.; ERS Global Lung Function Initiative. Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations. Eur Respir J. 2012;40:1324–1343.
Verleden GM, Glanville AR, Lease ED, et al. Chronic lung allograft dysfunction: definition, diagnostic criteria, and approaches to treatment—a consensus report from the Pulmonary Council of the ISHLT. J Heart Lung Transplant. 2019;38:493–503.
Leuschner G, Lauseker M, Howanietz A-S, et al. Longitudinal lung function measurements in single lung transplant recipients with chronic lung allograft dysfunction. J heart lung transplant. 2020;39:1270–1278.
Liu J, Jackson K, Weinkauf J, et al. Baseline lung allograft dysfunction is associated with impaired survival after double-lung transplantation. J Heart Lung Transplant. 2018;37:895–902.
Darley DR, Nilsen K, Vazirani J, et al. Airway oscillometry parameters in baseline lung allograft dysfunction: associations from a multicenter study. J Heart Lung Transplant. 2023;42:767–777.
Li D, Weinkauf J, Kapasi A, et al. Baseline lung allograft dysfunction in primary graft dysfunction survivors after lung transplantation. Respir Med. 2021;188:106617.
Graham BL, Steenbruggen I, Miller MR, et al. Standardization of spirometry 2019 update. An official American Thoracic Society and European Respiratory Society Technical Statement. Am J Respir Crit Care Med. 2019;200:e70–e88.
Kneidinger N, Milger K, Janitza S, et al. Lung volumes predict survival in patients with chronic lung allograft dysfunction. Eur Respir J. 2017;49:1601315.
Watz H, Tetzlaff K, Magnussen H, et al. Spirometric changes during exacerbations of COPD: a post hoc analysis of the WISDOM trial. Respir Res. 2018;19:251.
Waskom M. seaborn: statistical data visualization. J Open Source Software. 2021;6:3021.
Paraskeva MA, Borg BM, Paul E, et al. Abnormal one-year post-lung transplant spirometry is a significant predictor of increased mortality and chronic lung allograft dysfunction. J Heart Lung Transplant. 2021;40:1649–1657.
Belloli EA, Wang X, Murray S, et al. Longitudinal forced vital capacity monitoring as a prognostic adjunct after lung transplantation. Am J Respir Crit Care Med. 2015;192:209–218.
Eberlein M, Reed RM, Permutt S, et al. Parameters of donor-recipient size mismatch and survival after bilateral lung transplantation. J Heart Lung Transplant. 2012;31:1207–1213.e7.
Bellemare JF, Cordeau MP, Leblanc P, et al. Thoracic dimensions at maximum lung inflation in normal subjects and in patients with obstructive and restrictive lung diseases. Chest. 2001;119:376–386.
Yu WS, Park CH, Paik HC, et al. Changes in thoracic cavity volume after bilateral lung transplantation. Front Med (Lausanne). 2022;9:881119.
Li D, Weinkauf J, Hirji A, et al. Chest X-ray sizing for lung transplants reflects pulmonary diagnosis and body composition and is associated with primary graft dysfunction risk. Transplantation. 2021;105:382–389.