Abnormal one-year post-lung transplant spirometry is a significant predictor of increased mortality and chronic lung allograft dysfunction

Miranda A Paraskeva; Brigitte M Borg; Eldho Paul; Jeremy Fuller; Glen P Westall; Gregory I Snell

doi:10.1016/j.healun.2021.08.003

Abnormal one-year post-lung transplant spirometry is a significant predictor of increased mortality and chronic lung allograft dysfunction

J Heart Lung Transplant. 2021 Dec;40(12):1649-1657. doi: 10.1016/j.healun.2021.08.003. Epub 2021 Aug 21.

Authors

Miranda A Paraskeva¹, Brigitte M Borg², Eldho Paul³, Jeremy Fuller⁴, Glen P Westall⁴, Gregory I Snell⁴

Affiliations

¹ Lung Transplant Service, Alfred Hospital, Melbourne, Australia; Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia. Electronic address: m.paraskeva@alfred.org.au.
² Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia; School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia.
³ Department of Clinical Hematology, Alfred Hospital, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
⁴ Lung Transplant Service, Alfred Hospital, Melbourne, Australia; Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia.

PMID: 34548197
DOI: 10.1016/j.healun.2021.08.003

Abstract

Background: The prognostic value of evaluating spirometry at a fixed time point using standardized population reference has not previously been evaluated. Our aim was to assess the association between spirometric phenotype at 12 months (Spiro_12M), survival and incidence of chronic lung allograft dysfunction (CLAD) in bilateral lung transplant recipients.

Methods: We conducted a retrospective cohort study of bilateral lung transplant recipients transplanted between January 2003 and September 2012. We defined Spiro_12M as the mean of the 2 prebronchodilator FEV₁ measurements 12-month post-transplant. Normal spirometry was defined as FEV₁/FVC ≥0.7 and FEV1≥80% and FVC≥80% predicted population-based values for that recipient. Abnormal spirometry was defined as failure to attain normal function by 12-months. We used a Cox regression model to assess the association between Spiro_12M, survival, and CLAD. We used logistic regression to assess potential pretransplant donor and recipient factors associated with abnormal Spiro_12M RESULTS: One hundred and eleven (51%) lung transplant recipients normalized their Spiro_12M. Normal Spiro_12M was associated improved survival (hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.41-0.88], p = 0.009. Each 10% decrement in FEV₁ increased the risk of death in a stepwise fashion. Additionally, CLAD was reduced in those with normal Spiro_12M (HR:0.65, 95%CI:0.46-0.92, p = 0.016). Donor smoking history (OR:2.93, 95% CI:1.21-7.09; p = 0.018) and mechanical ventilation time in hours (OR:1.03, 95% CI:1.004-1.05; p = 0.02) were identified as independent predictors of abnormal Spiro_12M.

Conclusions: Abnormal Spiro_12M is associated with increased mortality and the development of CLAD. The effect is dose dependent with increased dysfunction corresponding to increased risk. This assessment of phenotype at 12-months can easily be incorporated into standard of care.

Keywords: chronic lung allograft dysfunction; lung physiology; lung transplantation; mortality; outcomes.

MeSH terms

Adult
Female
Forced Expiratory Volume
Graft Rejection / diagnosis
Graft Rejection / epidemiology*
Humans
Incidence
Lung Diseases / mortality*
Lung Diseases / surgery*
Lung Transplantation / adverse effects*
Male
Middle Aged
Predictive Value of Tests
Primary Graft Dysfunction / diagnosis
Primary Graft Dysfunction / epidemiology*
Retrospective Studies
Spirometry*
Survival Rate
Treatment Outcome