Airway oscillometry parameters in baseline lung allograft dysfunction: Associations from a multicenter study

David Ross Darley; Kris Nilsen; Jaideep Vazirani; Brigitte M Borg; Bronwyn Levvey; G Snell; Marshall Lawrence Plit; Katrina O Tonga

doi:10.1016/j.healun.2022.12.026

Airway oscillometry parameters in baseline lung allograft dysfunction: Associations from a multicenter study

J Heart Lung Transplant. 2023 Jun;42(6):767-777. doi: 10.1016/j.healun.2022.12.026. Epub 2023 Jan 6.

Authors

David Ross Darley¹, Kris Nilsen², Jaideep Vazirani², Brigitte M Borg³, Bronwyn Levvey², G Snell², Marshall Lawrence Plit⁴, Katrina O Tonga⁵

Affiliations

¹ Lung Transplant Unit, St Vincent's Hospital Sydney, Darlinghurst NSW, Australia; School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, UNSW Medicine & Health, UNSW Sydney, Australia. Electronic address: David.Darley@svha.org.au.
² Lung Transplant Service, The Alfred Hospital, Melbourne, Australia.
³ Respiratory Medicine, The Alfred Hospital, Melbourne, Australia.
⁴ Lung Transplant Unit, St Vincent's Hospital Sydney, Darlinghurst NSW, Australia; School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, UNSW Medicine & Health, UNSW Sydney, Australia.
⁵ School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, UNSW Medicine & Health, UNSW Sydney, Australia; Thoracic Medicine Department, St Vincent's Hospital Darlinghurst, Sydney, Australia; Northern Clinical School, Sydney Medical School, Faculty of Medicine & Health, University of Sydney, Sydney, Australia.

PMID: 36681528
DOI: 10.1016/j.healun.2022.12.026

Abstract

Background: Baseline lung allograft dysfunction (BLAD), the failure to achieve ≥80%-predicted spirometry after lung transplant (LTx), is associated with impaired survival. Physiologic abnormalities in BLAD are poorly understood. Airway oscillometry measures respiratory system mechanics and may provide insight into understanding the mechanisms of BLAD.

Objectives: This study aims to describe and measure the association between airway oscillometry parameters [Reactance (X_rs5, Ax), Resistance (R_rs5, R_rs5-19)] (1) stable LTx recipients, comparing those with normal spirometry and those with BLAD; and (2) in recipients with chronic lung allograft dysfunction (CLAD), comparing those with normal baseline spirometry and those with BLAD.

Methods: A multi-center cross-sectional study was performed including bilateral LTx between January 2020 and June 2021. Participants performed concurrent airway oscillometry and spirometry. Multivariable logistic regression was performed to measure the association between oscillometry parameters and BLAD.

Results: A total of 404 LTx recipients performed oscillometry and 253 were included for analysis. Stable allograft function was confirmed in 149 (50.2%) recipients (92 (61.7%) achieving normal spirometry and 57 (38.3%) with BLAD). Among stable LTx recipients, lower X_rs5 Z-Score (aOR 0.50 95% CI 0.37-0.76, p = 0.001) was independently associated with BLAD. CLAD was present in 104 (35.0%) recipients. Among recipients with CLAD, lower X_rs5 Z-Score (aOR 0.73 95% CI 0.56-0.95, p = 0.02) was associated with BLAD.

Conclusions: Oscillometry provides novel physiologic insights into mechanisms of BLAD. The independent association between X_rs5 and BLAD, in both stable recipients and those with CLAD suggests that respiratory mechanics, in particular abnormal elastance, is an important physiologic feature. Further longitudinal studies are needed to understand the trajectory of oscillometry parameters in relation to allograft outcomes.

Keywords: chronic lung allograft dysfunction (CLAD); lung transplant (LTx); oscillometry; reactance; resistance.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Allografts
Cross-Sectional Studies
Humans
Lung Transplantation*
Lung*
Oscillometry
Respiratory Function Tests
Spirometry