Original clinical scienceAcute Cellular Rejection Is a Risk Factor for Bronchiolitis Obliterans Syndrome Independent of Post-transplant Baseline FEV1
Section snippets
Methods
All patients receiving SLT, BLT or combination heart–lung transplantation (HLT) at the Danish National Centre for Lung Transplantation, Copenhagen University Hospital, Rigshospital, during the period 1992 to 2004, were included in the analysis (n = 389). Patients not surviving at least 3 months after transplantation were not considered to be at risk of developing BOS (n = 39) and were excluded from the study. Patients for whom there were insufficient or missing lung function measurements were
Results
A total of 346 (89%) consecutive patients were evaluated with respect to the development of BOS. Basic demographic information on these patients is shown in Table 1.
The first maximum FEV1 used in the calculation of baseline FEV1 occurred at a median 183 (quartiles 72, 366) days post-transplant.
The freedom from BOS, BOS-free survival and cumulative incidence of BOS according to type of transplant is shown in Figure 1. In this cohort, the overall freedom from BOS Grade 1 was 81%, 53%, 38% and 15%
Discussion
In this study we have evaluated a number of recipient and donor demographic and clinical risk factors for the development of BOS Grade 1. This is the first study to correct for the overall size of the transplanted lung and address the inherent bias of determining BOS grade as a proportion of baseline lung function. The main findings were: (1) baseline lung function remained a strong confounder in all analyses of freedom from and cumulative incidence of BOS; and (2) increased exposure to ACR
Disclosure Statement
Supported by a PhD grant from the University of Copenhagen.
References (24)
- et al.
Bronchiolitis obliterans syndrome 2001: an update of the diagnostic criteria
J Heart Lung Transplant
(2002) - et al.
Registry of the International Society for Heart and Lung Transplantation: twenty-third official adult lung and heart–lung transplantation report—2006
J Heart Lung Transplant
(2006) - et al.
Long-term survival after lung transplantation depends on development and severity of bronchiolitis obliterans syndrome
J Heart Lung Transplant
(2007) - et al.
Post-transplant baseline FEV1 and the development of bronchiolitis obliterans syndrome: an important confounder?
J Heart Lung Transplant
(2007) - et al.
The Copenhagen National Lung Transplant Group: survival after single lung, double lung, and heart–lung transplantation
J Heart Lung Transplant
(2005) - et al.
The incidence of acute cellular rejection after lung transplantation: a comparative study of anti-thymocyte globulin and daclizumab
J Heart Lung Transplant
(2006) - et al.
Minimal acute rejection after lung transplantation: a risk for bronchiolitis obliterans syndrome
Am J Transplant
(2005) - et al.
Transforming growth factor beta (TGF-beta) and obliterative bronchiolitis following pulmonary transplantation
J Heart Lung Transplant
(1999) - et al.
Bronchiolitis obliterans in recipients of single, double, and heart–lung transplantation
Chest
(1995) - et al.
Risk factors for the development of bronchiolitis obliterans syndrome after lung transplantation
J Thorac Cardiovasc Surg
(1997)
Risk factors for bronchiolitis obliterans: a systematic review of recent publications
J Heart Lung Transplant
Donor–recipient gender mismatch in lung transplantation: impact on obliterative bronchiolitis and survival
J Heart Lung Transplant
Cited by (106)
Organizing pneumonia is associated with molecular allograft injury and the development of antibody-mediated rejection
2024, Journal of Heart and Lung TransplantationLung transplantation in France, state of play
2024, Bulletin de l'Academie Nationale de MedecineCenter variability in the prognostic value of a cumulative acute cellular rejection “A-score” for long-term lung transplant outcomes
2024, American Journal of TransplantationImpact of age and telomere length on circulating T cells and rejection risk after lung transplantation for idiopathic pulmonary fibrosis
2023, Journal of Heart and Lung TransplantationReflux Surgery in Lung Transplantation: A Multicenter Retrospective Study
2023, Annals of Thoracic Surgery