Published ahead of print on May 13, 2005, doi:10.1164/rccm.200501-097OC Am. J. Respir. Crit. Care Med., Volume 172, Number 3, August 2005, 379-383 A more recent version of this article appeared on August 1, 2005
Submitted on January 21, 2005 Prognostic Value of Bronchiolitis Obliterans Syndrome Stage 0-p in Single Lung Transplant RecipientsVibha N Lama1*,1 Division of Pulmonary and Critical Care Medicine, University of Michigan School of Public Health, Ann Arbor, MI, USA, 2 Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA, 3 Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, MI, USA * To whom correspondence should be addressed. E-mail: vlama{at}umich.edu.
Rationale: Early diagnosis of bronchiolitis obliterans syndrome (BOS) is critical in understanding pathogenesis and devising therapeutic trials. Although potential-BOS stage (BOS 0-p), encompassing early changes in FEV1 and FEF25-75%, has been proposed, there is a paucity of data validating its utility in single lung transplantation. Objective: The aim of this study was to define the predictive ability of BOS 0-p in single lung transplantation. Methods: We retrospectively analyzed spirometric data for 197 single lung recipients. Sensitivity, specificity and positive predictive value of BOS 0-p was examined over time using Kaplan-Meier methodology. Results: BOS 0-p FEV1 was associated with higher sensitivity, specificity and positive predictive value than the FEF25-75% criterion over different time periods investigated. The probability of testing positive for BOS 0-p FEV1 in patients with BOS (sensitivity) was 71% at 2 years before the onset of BOS. The probability of being free from development of BOS 0-p FEV1 in patients free of BOS at follow-up (specificity) was 93% within the last year. Eighty-one percent of patients who met BOS 0-p FEV1 criterion developed BOS or died within 3 years. The specificity and positive predictive value curves for the BOS 0-p FEV1 were significantly different between patients with underlying restrictive versus obstructive physiology (p=0.05 and 0.01 respectively). Conclusion: FEV1 criterion for BOS 0-p provides useful predictive information regarding the risk of development of BOS or death in single lung recipients. The predictive value of this criterion is higher in patients with underlying restriction and is superior to the FEF25-75% criterion. Key words: bronchiolitis obliterans syndrome; lung transplantation; diagnosis; staging
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