Jonathan Liu1, Kathy Jackson1, Justin Weinkauf2, Ali Kapasi2, Alim Hirji2, Steve Meyer3, John Mullen3, Jayan Nagendran3, Dale Lien2, Kieran Halloran4. 1. Lung Transplant Program, University of Alberta, Edmonton, Alberta, Canada. 2. Lung Transplant Program, University of Alberta, Edmonton, Alberta, Canada; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. 3. Lung Transplant Program, University of Alberta, Edmonton, Alberta, Canada; Department of Surgery, University of Alberta, Edmonton, Alberta, Canada. 4. Lung Transplant Program, University of Alberta, Edmonton, Alberta, Canada; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. Electronic address: kieran.halloran@ualberta.ca.
Abstract
BACKGROUND: The prognostic value of defining normal vs abnormal baseline post-transplant lung function (or baseline lung allograft dysfunction [BLAD]) has not been studied using standardized reference values of percent predicted of the population. Our aim was to assess the association between BLAD and survival in double-lung transplant recipients and assess for potential pre-transplant donor and recipient risk factors for BLAD. METHODS: We conducted a retrospective cohort study of double-lung transplant recipients in our program during the period 2004 to 2009. We defined normal baseline function as both forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) ≥80% predicted on at least 2 consecutive tests ≥3 weeks apart; we defined BLAD as failure to meet these criteria. We used a Cox regression model to assess the association between BLAD and survival. We used logistic regression to assess potential pre-transplant donor and recipient factors associated with BLAD. RESULTS: Of 178 patients double-lung transplant recipients eligible for study, 75 (42%) met the criteria for BLAD. BLAD was associated with impaired survival (hazard ratio [HR] 2.23, 95% confidence interval [CI] 1.41 to 3.54]) via Cox regression compared to patients with normal baseline, and lower baseline was associated with greater risk of death in a dose-dependent fashion. Pre-transplant factors associated with BLAD included interstitial lung disease (ILD) as an indication for transplant (odds ratio [OR] 2.66, 95% CI 1.17 to 6.15) and heavy donor smoking history (OR 3.07, 95% CI 1.17 to 8.43). CONCLUSIONS: BLAD is dynamic risk state associated with impaired survival after double-lung transplantation, and should be considered when physiologically phenotyping patients.
BACKGROUND: The prognostic value of defining normal vs abnormal baseline post-transplant lung function (or baseline lung allograft dysfunction [BLAD]) has not been studied using standardized reference values of percent predicted of the population. Our aim was to assess the association between BLAD and survival in double-lung transplant recipients and assess for potential pre-transplant donor and recipient risk factors for BLAD. METHODS: We conducted a retrospective cohort study of double-lung transplant recipients in our program during the period 2004 to 2009. We defined normal baseline function as both forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) ≥80% predicted on at least 2 consecutive tests ≥3 weeks apart; we defined BLAD as failure to meet these criteria. We used a Cox regression model to assess the association between BLAD and survival. We used logistic regression to assess potential pre-transplant donor and recipient factors associated with BLAD. RESULTS: Of 178 patients double-lung transplant recipients eligible for study, 75 (42%) met the criteria for BLAD. BLAD was associated with impaired survival (hazard ratio [HR] 2.23, 95% confidence interval [CI] 1.41 to 3.54]) via Cox regression compared to patients with normal baseline, and lower baseline was associated with greater risk of death in a dose-dependent fashion. Pre-transplant factors associated with BLAD included interstitial lung disease (ILD) as an indication for transplant (odds ratio [OR] 2.66, 95% CI 1.17 to 6.15) and heavy donor smoking history (OR 3.07, 95% CI 1.17 to 8.43). CONCLUSIONS: BLAD is dynamic risk state associated with impaired survival after double-lung transplantation, and should be considered when physiologically phenotyping patients.
Authors: Joseph B Pryor; Miranda C Bradford; Ann L Jennerich; Travis Y Hee Wai; Joseph M Pilewski; Siddhartha G Kapnadak; Moira L Aitken; Christopher H Goss; Kathleen J Ramos Journal: Ann Am Thorac Soc Date: 2022-07
Authors: Chen Yang Kevin Zhang; Musawir Ahmed; Ella Huszti; Liran Levy; Sarah E Hunter; Kristen M Boonstra; Sajad Moshkelgosha; Andrew T Sage; Sassan Azad; Rasheed Ghany; Jonathan C Yeung; Oscar M Crespin; Lianne G Singer; Shaf Keshavjee; Tereza Martinu Journal: Respir Res Date: 2022-08-26