Published ahead of print on March 8, 2007, doi:10.1164/rccm.200609-1344OC
© 2007 American Thoracic Society doi: 10.1164/rccm.200609-1344OC
Course of FEV1 after Onset of Bronchiolitis Obliterans Syndrome in Lung Transplant Recipients1 Division of Pulmonary and Critical Care Medicine, and 2 Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan; and 3 Section of Thoracic Surgery, and 4 Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan Correspondence and requests for reprints should be addressed to Vibha N. Lama, M.D., M.S., Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, 1500 East Medical Center Drive, 3916 Taubman Center, Ann Arbor, MI 48109–0360. E-mail: vlama{at}umich.edu Rationale: Bronchiolitis obliterans syndrome (BOS), defined by loss of lung function, develops in the majority of lung transplant recipients. However, there is a paucity of information on the subsequent course of lung function in these patients. Objectives: To characterize the course of FEV1 over time after development of BOS and to determine the predictors that influence the rate of functional decline of FEV1. Methods: FEV1% predicted (FEV1%pred) trajectories were studied in 111 lung transplant recipients with BOS by multivariate, linear, mixed-effects statistical models. Measurements and Main Results: FEV1%pred varied over time after BOS onset, with the steepest decline typically seen in the first 6 months (12% decline; p < 0.0001). Bilateral lung transplant recipients had significantly higher FEV1%pred at BOS diagnosis (71 vs. 47%; p < 0.0001) and at 24 months after BOS onset (58 vs. 41%; p = 0.0001). Female gender and pretransplant diagnosis of idiopathic pulmonary fibrosis were associated with a steeper decline in FEV1%pred in the first 6 months after BOS diagnosis (p = 0.02 and 0.04, respectively). A fall in FEV1 greater than 20% in the 6 months preceding BOS (termed "rapid onset") was associated with shorter time to BOS onset (p = 0.01), lower FEV1%pred at BOS onset (p < 0.0001), steeper decline in the first 6 months (p = 0.03), and lower FEV1%pred at 2 years after onset (p = 0.0002). Conclusions: Rapid onset of BOS, female gender, pretransplant diagnosis of idiopathic pulmonary fibrosis, and single-lung transplantation are associated with worse pulmonary function after BOS onset.
Key Words: bronchiolitis obliterans syndrome • FEV1 • pulmonary function • prognosis
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