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. 2005 Aug 1;172(3):379-83.
doi: 10.1164/rccm.200501-097OC. Epub 2005 May 13.

Prognostic value of bronchiolitis obliterans syndrome stage 0-p in single-lung transplant recipients

Vibha N Lama  1 , Susan Murray, Jeanette A Mumford, Kevin R Flaherty, Andrew Chang, Galen B Toews, Marc Peters-Golden, Fernando J Martinez
Affiliations

Prognostic value of bronchiolitis obliterans syndrome stage 0-p in single-lung transplant recipients

Vibha N Lama et al. Am J Respir Crit Care Med. .

Abstract

Rationale: Early diagnosis of bronchiolitis obliterans syndrome (BOS) is critical in understanding pathogenesis and devising therapeutic trials. Although potential-BOS stage (BOS 0-p), encompassing early changes in FEV(1) and forced expiratory flow, midexpiratory phase (FEF(25-75%)), has been proposed, there is a paucity of data validating its utility in single-lung transplantation.

Objective: The aim of this study was to define the predictive ability of BOS 0-p in single-lung transplantation.

Methods: We retrospectively analyzed spirometric data for 197 single-lung recipients. Sensitivity, specificity, and positive predictive value of BOS 0-p were examined over time using Kaplan-Meier methodology.

Results: BOS 0-p FEV(1) was associated with higher sensitivity, specificity, and positive predictive value than the FEF(25-75%) criterion over different time periods investigated. The probability of testing positive for BOS 0-p FEV(1) in patients with BOS (sensitivity) was 71% at 2 years before the onset of BOS. The probability of being free from development of BOS 0-p FEV(1) in patients free of BOS at follow-up (specificity) was 93% within the last year. Of patients who met the BOS 0-p FEV(1) criterion, 81% developed BOS or died within 3 years. The specificity and positive predictive value curves for the BOS 0-p FEV(1) were significantly different between patients with underlying restrictive versus obstructive physiology (p = 0.05 and 0.01, respectively).

Conclusion: The FEV(1) criterion for BOS 0-p provides useful predictive information regarding the risk of development of BOS or death in single-lung recipients. The predictive value of this criterion is higher in patients with underlying restriction and is superior to the FEF(25-75%) criterion.

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Figures

<b>Figure 1.</b>
Figure 1.
Freedom from bronchiolitis obliterans syndrome (BOS) and potential BOS stage (BOS 0-p) by each criterion from the time of transplantation.
<b>Figure 2.</b>
Figure 2.
Sensitivity curves of BOS 0-p by each criterion in single-lung transplant recipients. The sensitivity curve as a function of time, t, is defined as the probability of having BOS 0-p at t units of time before onset of BOS among patients who ultimately develop BOS. The time along the horizontal axis indicates the length of the time before meeting the BOS criterion.
<b>Figure 3.</b>
Figure 3.
Specificity curves of BOS 0-p by each criterion over time in single-lung transplant recipients. The specificity curve as a function of time, t, is defined as the probability of not meeting BOS 0-p criteria within the previous t units of time from the last pulmonary function test among patients who were not diagnosed with BOS. The time on the horizontal axis is the length of time before the last observed pulmonary function test.
<b>Figure 4.</b>
Figure 4.
Positive predictive value of BOS 0-p by each criterion over time in single-lung transplant recipients (freedom from BOS or death after the onset of BOS 0-p).
<b>Figure 5.</b>
Figure 5.
Sensitivity (A), specificity (B), and positive predictive value (C) for obstructive (solid lines) and restrictive (dashed lines) lung disease for BOS 0-p defined by both FEV1 (thin lines) and FEF25–75% (bold lines) criteria. The sensitivity for obstructive versus restrictive lung disease was not significantly different for BOS 0-p FEV1 (p = 0.24), but was significantly different for BOS 0-p FEF25–75% (p = 0.04). The specificity for obstructive versus restrictive lung disease was significantly different for BOS 0-p FEV1 (p = 0.05), but was not significantly different for BOS 0-p FEF25–75% (p = 0.31). The positive predictive values for obstructive versus restrictive lung disease was significantly different for BOS 0-p FEV1 (p = 0.01), but was not significantly different for BOS 0-p FEF25–75% (p = 0.44).
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