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Published ahead of print on December 11, 2003, doi:10.1164/rccm.200307-1018OC

Am. J. Respir. Crit. Care Med., Volume 169, Number 4, February 2004, 468-472

A more recent version of this article appeared on February 15, 2004
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Submitted on July 31, 2003
Accepted on December 5, 2003

The Predictive Value of Bronchiolitis Obliterans Syndrome Stage 0-p

Ramsey R Hachem1*, Murali M Chakinala1, Roger D Yusen1, John P Lynch1, Aviva A Aloush2, G. Alexander Patterson2, and Elbert P Trulock1

1 Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO, USA, 2 Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA

* To whom correspondence should be addressed. E-mail: rhachem{at}im.wustl.edu.

Bronchiolitis obliterans syndrome 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 bronchiolitis obliterans syndrome 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 one year, while only 37% of those who developed stage 0-p by the FEF25-75 criterion progressed to stage 1 within one year. We conclude that the FEV1 criterion for stage 0-p is a reasonable predictor of bronchiolitis obliterans syndrome stage 1 after bilateral lung transplantation, but the FEF25-75 criterion for stage 0-p is not predictive of bronchiolitis obliterans syndrome stage 1 after bilateral lung transplantation.
Key words: Lung transplantation, chronic rejection, diagnosis, spirometry




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