Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Mar;12(3):745-52.
doi: 10.1111/j.1600-6143.2011.03849.x. Epub 2011 Nov 28.

Spirometrically significant acute rejection increases the risk for BOS and death after lung transplantation

W A Davis  1 , C A Finlen Copeland, J L Todd, L D Snyder, J A Martissa, S M Palmer
Affiliations

Spirometrically significant acute rejection increases the risk for BOS and death after lung transplantation

W A Davis et al. Am J Transplant. 2012 Mar.

Abstract

Acute rejection (AR) is a common complication following lung transplantation and is an established risk factor for bronchiolitis obliterans syndrome (BOS). AR clinical presentation varies considerably and is sometimes associated with an acute decrease in forced expiratory volume in 1 s (FEV1). We hypothesized that lung transplant recipients who experience such spirometrically significant AR (SSAR), as defined by a ≥10% decline in FEV1 relative to the prior pulmonary function test, are subsequently at increased risk for BOS and worse overall survival. In a large single center cohort (n = 339), SSAR occurred in 79 subjects (23%) and significantly increased the risk for BOS (p < 0.0001, HR = 3.2, 95% CI 2.3-4.6) and death (p = 0.0001, HR = 2.3, 95% CI 1.5-3.5). These effects persisted after multivariate adjustment for pre-BOS AR and lymphocytic bronchiolitis burden. An analysis of the subset of patients who experienced severe SSAR (≥20% decline in FEV1) resulted in even greater hazards for BOS and death. Thus, we demonstrate a novel physiological measure that allows discrimination of patients at increased risk for worse posttransplant outcomes. Further studies are needed to determine mechanisms of airflow impairment and whether aggressive clinical interventions could improve post-SSAR outcomes.

PubMed Disclaimer

Conflict of interest statement

Disclosure

This manuscript was neither prepared nor funded in any part by a commercial organization. The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

Figures

Figure 1
Figure 1
Patient flow through the study. The cohort is comprised of 339 (79 SSAR and 260 non-SSAR) subjects who underwent sufficient biopsy and PFT procedures and experienced at least one AR event prior to BOS; AR, acute rejection; BOS, bronchiolitis obliterans syndrome; PFT, pulmonary function test; SSAR, spirometrically significant acute rejection.
Figure 2
Figure 2
Timing of SSAR and non-SSAR episodes after transplantation (box-and-whisker plot). SSAR episodes occurred an average of 818 (median: 639, IQR: 71 – 1275) days posttransplant while non-SSAR episodes occurred an average of 606 (median: 361, IQR: 90 –828) days posttransplant; max upper whisker = upper quartile + (1.5 * IQR); ‡Median (IQR); ◊ Mean; ○ value > upper whisker; SSAR, spirometrically significant acute rejection.
See this image and copyright information in PMC

References

    1. Christie JD, Edwards LB, Kucheryavaya AY, Aurora P, Dobbels F, Kirk R, et al. The Registry of the International Society for Heart and Lung Transplantation: twenty-seventh official adult lung and heart-lung transplant report--2010. J Heart Lung Transplant. 2010 Oct;29(10):1104–18. - PubMed
    1. Belperio JA, Weigt SS, Fishbein MC, Lynch JP., 3rd Chronic lung allograft rejection: mechanisms and therapy. Proc Am Thorac Soc. 2009 Jan 15;6(1):108–21. - PubMed
    1. Bowdish ME, Arcasoy SM, Wilt JS, Conte JV, Davis RD, Garrity ER, et al. Surrogate markers and risk factors for chronic lung allograft dysfunction. Am J Transplant. 2004 Jul;4(7):1171–8. - PubMed
    1. Estenne M, Maurer JR, Boehler A, Egan JJ, Frost A, Hertz M, et al. Bronchiolitis obliterans syndrome 2001: an update of the diagnostic criteria. J Heart Lung Transplant. 2002 Mar;21(3):297–310. - PubMed
    1. Scott AI, Sharples LD, Stewart S. Bronchiolitis obliterans syndrome: risk factors and therapeutic strategies. Drugs. 2005;65(6):761–71. - PubMed

Publication types

MeSH terms