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Published ahead of print on December 11, 2003, doi:10.1164/rccm.200307-1018OC
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American Journal of Respiratory and Critical Care Medicine Vol 169. pp. 468-472, (2004)
© 2004 American Thoracic Society

The Predictive Value of Bronchiolitis Obliterans Syndrome Stage 0-p

Ramsey R. Hachem, Murali M. Chakinala, Roger D. Yusen, John P. Lynch, Aviva A. Aloush, G. Alexander Patterson and Elbert P. Trulock

Division of Pulmonary and Critical Care Medicine; and Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri

Correspondence and requests for reprints should be addressed to Ramsey R. Hachem, M.D., Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine (Campus Box 8052), 660 South Euclid Avenue, St. Louis, MO 63110. E-mail: rhachem{at}im.wustl.edu

Bronchiolitis obliterans syndrome (BOS) remains the main cause of graft loss after lung transplantation. Stage 0-p was recently added to the staging criteria to detect early deterioration in allograft function that might presage BOS stage 1. We assessed the predictive value of stage 0-p by retrospectively analyzing spirometric data for 203 adult bilateral lung transplant recipients. The FEV1 criterion for stage 0-p had a positive predictive value of 79% and a negative predictive value of 82%. In contrast, the FEF25–75% criterion for stage 0-p had a positive predictive value of 52% and a negative predictive value of 72%. Fifty-seven percent of subjects who developed stage 0-p by the FEV1 criterion progressed to stage 1 within 1 year, whereas only 37% of those who developed stage 0-p by the FEF25–75% criterion progressed to stage 1 within 1 year. We conclude that the FEV1 criterion for stage 0-p is a reasonable predictor of BOS stage 1 after bilateral lung transplantation, but the FEF25–75% criterion for stage 0-p is not predictive of BOS stage 1 after bilateral lung transplantation.

Key Words: lung transplantation • chronic rejection • diagnosis • spirometry




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