Hope E Karnes1, Emily I Schindler2, Matt Morrell3, Ramsey R Hachem4, Keith Berman5, Suresh Vedantham6, Jeff Atkinson4, Edward Spitznagel7,8, George John Despotis9,10. 1. Cincinnati VA Medical Center, University of Cincinnati Medical Center, Cincinnati, OH. 2. St. Louis Pathology Associates, Department of Pathology, Mercy Medical, St. Louis, MO. 3. Division of Pulmonology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. 4. Division of Pulmonology, Department of Medicine, Washington University School of Medicine, St. Louis, MO. 5. Health Research Associates, Altadena, CA. 6. Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO. 7. Department of Biostatistics, Washington University School of Medicine, St. Louis, MO. 8. Department of Mathematics, Washington University, St. Louis, MO. 9. Division of Laboratory & Genomic Medicine, Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO. 10. Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO.
Abstract
BACKGROUND: This study was designed to identify factors associated with clinical response to extracorporeal photopheresis (ECP) and mortality after ECP in lung allograft recipients with bronchiolitis obliterans. METHODS: Forced expiratory volume in 1 second (FEV1) values obtained 6 months before (baseline) and 6 months after initiation of ECP were used to plot the linear relationship between FEV1 versus time before and after ECP. Response to ECP was assigned when a positive integer was derived after subtracting the baseline rate of decline from the rate of decline 6 months after ECP. Univariate and multivariate logistic regression analyses were used to identify demographic, treatment-related factors or spirometric parameters that may be associated with response to ECP or mortality at either 6 or 16 months after initiation of ECP. RESULTS: Forced expiratory volume in 1 second just before ECP was associated with mortality (P = 0.007) at 16 months after ECP initiation. An FEV1 of 1.50 L or less had a sensitivity of 87% and specificity of 60% to identify patients who died within 16 months after ECP initiation. Patients whose FEV1 decline exceeded 40 mL/month were 12 times more likely to have a response to ECP (P = 0.0001). Patients whose decline in FEV1 before ECP was statistically significant (P < 0.05) were nearly 10 times (P = 0.008) more likely to respond to ECP. CONCLUSIONS: Forced expiratory volume in 1 second is an important predictor of mortality, and the response to ECP is influenced by both the extent (>40 mL/mo) and statistical significance of the relationship between FEV1 versus time before ECP initiation. Therefore, earlier bronchiolitis obliterans detection and more timely implementation of ECP (ie, when FEV1 values >1.5 L) should be considered especially in patients with a more aggressive rate of decline of lung function.
BACKGROUND: This study was designed to identify factors associated with clinical response to extracorporeal photopheresis (ECP) and mortality after ECP in lung allograft recipients with bronchiolitis obliterans. METHODS: Forced expiratory volume in 1 second (FEV1) values obtained 6 months before (baseline) and 6 months after initiation of ECP were used to plot the linear relationship between FEV1 versus time before and after ECP. Response to ECP was assigned when a positive integer was derived after subtracting the baseline rate of decline from the rate of decline 6 months after ECP. Univariate and multivariate logistic regression analyses were used to identify demographic, treatment-related factors or spirometric parameters that may be associated with response to ECP or mortality at either 6 or 16 months after initiation of ECP. RESULTS: Forced expiratory volume in 1 second just before ECP was associated with mortality (P = 0.007) at 16 months after ECP initiation. An FEV1 of 1.50 L or less had a sensitivity of 87% and specificity of 60% to identify patients who died within 16 months after ECP initiation. Patients whose FEV1 decline exceeded 40 mL/month were 12 times more likely to have a response to ECP (P = 0.0001). Patients whose decline in FEV1 before ECP was statistically significant (P < 0.05) were nearly 10 times (P = 0.008) more likely to respond to ECP. CONCLUSIONS: Forced expiratory volume in 1 second is an important predictor of mortality, and the response to ECP is influenced by both the extent (>40 mL/mo) and statistical significance of the relationship between FEV1 versus time before ECP initiation. Therefore, earlier bronchiolitis obliterans detection and more timely implementation of ECP (ie, when FEV1 values >1.5 L) should be considered especially in patients with a more aggressive rate of decline of lung function.
Authors: Ashwini Arjuna; Michael T Olson; Rajat Walia; Ross M Bremner; Michael A Smith; Thalachallour Mohanakumar Journal: Expert Rev Respir Med Date: 2020-10-25 Impact factor: 3.772
Authors: Chadi A Hage; Julia Klesney-Tait; Keith Wille; Selim Arcasoy; Gordon Yung; Marshall Hertz; Kevin M Chan; Matt Morrell; Hilary Goldberg; Suresh Vedantham; Mary Clare Derfler; Paul Commean; Keith Berman; Ed Spitznagel; Jeff Atkinson; George Despotis Journal: Transfus Med Date: 2021-05-05 Impact factor: 2.019