Effects of donor smoking history on early post-transplant lung function measured by oscillometry

Natalia Belousova; Albert Cheng; John Matelski; Anastasiia Vasileva; Joyce K Y Wu; Rasheed Ghany; Tereza Martinu; Clodagh M Ryan; Chung-Wai Chow

doi:10.3389/fmed.2024.1328395

Effects of donor smoking history on early post-transplant lung function measured by oscillometry

Front Med (Lausanne). 2024 Apr 9:11:1328395. doi: 10.3389/fmed.2024.1328395. eCollection 2024.

Authors

Natalia Belousova^{1

2

3}, Albert Cheng², John Matelski³, Anastasiia Vasileva², Joyce K Y Wu⁴, Rasheed Ghany¹, Tereza Martinu^{1

2}, Clodagh M Ryan^{2

4}, Chung-Wai Chow^{1

2}

Affiliations

¹ Toronto Lung Transplant Program, Ajmera Multi-Organ Transplant Program and Division of Respirology, University Health Network, Tonronto, ON, Canada.
² Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
³ Pneumology, Aduch Cystic Fibrosis and Lung Transplantation Department, Foch Hospital, Suresnes, France.
⁴ Toronto General Pulmonary Function Laboratory, University Health Network, Toronto, ON, Canada.

Abstract

Introduction: Prior studies assessing outcomes of lung transplants from cigarette-smoking donors found mixed results. Oscillometry, a non-invasive test of respiratory impedance, detects changes in lung function of smokers prior to diagnosis of COPD, and identifies spirometrically silent episodes of rejection post-transplant. We hypothesise that oscillometry could identify abnormalities in recipients of smoking donor lungs and discriminate from non-smoking donors.

Methods: This prospective single-center cohort study analysed 233 double-lung recipients. Oscillometry was performed alongside routine conventional pulmonary function tests (PFT) post-transplant. Multivariable regression models were constructed to compare oscillometry and conventional PFT parameters between recipients of lungs from smoking vs non-smoking donors.

Results: The analysis included 109 patients who received lungs from non-smokers and 124 from smokers. Multivariable analysis identified significant differences between recipients of smoking and non-smoking lungs in the oscillometric measurements R_5-19, X₅, AX, R₅z and X₅z, but no differences in %predicted FEV₁, FEV₁/FVC, %predicted TLC or %predicted DLCO. An analysis of the smoking group also demonstrated associations between increasing smoke exposure, quantified in pack years, and all the oscillometry parameters, but not the conventional PFT parameters.

Conclusion: An interaction was identified between donor-recipient sex match and the effect of smoking. The association between donor smoking and oscillometry outcomes was significant predominantly in the female donor/female recipient group.

Keywords: donor selection; donor smoking history; lung function; lung transplant; oscillometry.

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. The study is supported by a grant-in-aid from the Lung Health Foundation, the Pettit Block Term Grants, the CIHR/NSERC Collaborative Health Research Program (grant # 282963) and the Ajmera Foundation Multi-Organ Transplant Innovation Fund. AV was supported by a University of Toronto Open Scholarship and Queen Elizabeth II/Institute of Medical Science Graduate Scholarships in Science & Technology (QEII-GSST).