BACKGROUND: Chronic lung allograft dysfunction (CLAD) is the main factor limiting long-term survival after lung transplantation. Besides bronchiolitis obliterans syndrome, a restrictive phenotype of CLAD (rCLAD) exists, which is associated with poor prognosis after diagnosis. However, survival determinants for rCLAD remain to be elucidated. Our aim in this study was to establish parameters predicting survival in patients with rCLAD. METHODS: All patients diagnosed with rCLAD in 2 lung transplant centers were assessed in a retrospective manner. Various clinical parameters [demography, pulmonary function, bronchoalveolar lavage (BAL), histopathology, radiology and blood differentials] at rCLAD diagnosis were correlated with graft survival using unadjusted and adjusted analysis. RESULTS: A total of 53 patients with rCLAD were included with a median graft survival after diagnosis of 1.1 years. Univariate analysis demonstrated that lower-lobe-dominant or diffuse infiltrates on chest computed tomography, presence of an identifiable trigger before rCLAD onset, lymphocytic bronchiolitis, increased BAL neutrophilia, increased BAL eosinophilia and increased blood eosinophils were associated with inferior graft survival after rCLAD diagnosis. Multivariate analysis confirmed the association of location of infiltrates and blood eosinophilia on graft survival. CONCLUSION: In this study we have identified parameters associated with graft survival after rCLAD diagnosis that may be useful to predict prognosis.
BACKGROUND:Chronic lung allograft dysfunction (CLAD) is the main factor limiting long-term survival after lung transplantation. Besides bronchiolitis obliterans syndrome, a restrictive phenotype of CLAD (rCLAD) exists, which is associated with poor prognosis after diagnosis. However, survival determinants for rCLAD remain to be elucidated. Our aim in this study was to establish parameters predicting survival in patients with rCLAD. METHODS: All patients diagnosed with rCLAD in 2 lung transplant centers were assessed in a retrospective manner. Various clinical parameters [demography, pulmonary function, bronchoalveolar lavage (BAL), histopathology, radiology and blood differentials] at rCLAD diagnosis were correlated with graft survival using unadjusted and adjusted analysis. RESULTS: A total of 53 patients with rCLAD were included with a median graft survival after diagnosis of 1.1 years. Univariate analysis demonstrated that lower-lobe-dominant or diffuse infiltrates on chest computed tomography, presence of an identifiable trigger before rCLAD onset, lymphocytic bronchiolitis, increased BAL neutrophilia, increased BAL eosinophilia and increased blood eosinophils were associated with inferior graft survival after rCLAD diagnosis. Multivariate analysis confirmed the association of location of infiltrates and blood eosinophilia on graft survival. CONCLUSION: In this study we have identified parameters associated with graft survival after rCLAD diagnosis that may be useful to predict prognosis.
Authors: Michael P Combs; Meng Xia; David S Wheeler; Elizabeth A Belloli; Natalie M Walker; Russell R Braeuer; Dennis M Lyu; Susan Murray; Vibha N Lama Journal: J Heart Lung Transplant Date: 2020-04-19 Impact factor: 10.247
Authors: Oscar Okwudiri Onyema; Yizhan Guo; Atsushi Hata; Daniel Kreisel; Andrew E Gelman; Elizabeth A Jacobsen; Alexander Sasha Krupnick Journal: Am J Transplant Date: 2019-11-18 Impact factor: 8.086
Authors: Jamie L Todd; Megan L Neely; C A Finlen Copeland; Courtney W Frankel; John M Reynolds; Scott M Palmer Journal: J Heart Lung Transplant Date: 2018-10-31 Impact factor: 10.247
Authors: Jan H von der Thüsen; Elly Vandermeulen; Robin Vos; Birgit Weynand; Erik K Verbeken; Stijn E Verleden Journal: Mod Pathol Date: 2018-01-12 Impact factor: 7.842
Authors: Alicia M Hinze; Cheng T Lin; Amira F Hussien; Jamie Perin; Aida Venado; Jeffrey A Golden; Francesco Boin; Robert H Brown; Robert A Wise; Fredrick M Wigley Journal: Rheumatology (Oxford) Date: 2020-04-01 Impact factor: 7.580
Authors: Mirza Novo; Johan Westin; Lars-Magnus Andersson; Anton Jonsson Berdenius; Rickard Nordén; Jasper M Magnusson Journal: Transplant Direct Date: 2021-07-19