Published ahead of print on May 13, 2005, doi:10.1164/rccm.200502-212OC Am. J. Respir. Crit. Care Med., Volume 172, Number 3, August 2005, 384-390 A more recent version of this article appeared on August 1, 2005
Submitted on February 10, 2005 Pretransplant Lung Function, Respiratory Failure, and Mortality After Stem Cell TransplantationTanyalak Parimon1,1 Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA, 2 Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA, USA * To whom correspondence should be addressed. E-mail: jchien{at}fhcrc.org.
Rationale: The role of pulmonary function prior to stem cell transplant as a potential risk factor for the development of early post transplant respiratory failure and mortality is controversial. Methods: We conducted a retrospective analysis of the pretransplant pulmonary function of 2,852 patients who received their transplant between 1990-2001. Measurements: Pretransplant FEV1, FVC, TLC, DLCO and P(A-a)O2 were measured and assessed for association with development of early respiratory failure and mortality in Cox proportional hazard logistic models. Main Results: In multivariate analyses, progressive decrease of all lung function parameters was associated with a step-wise increase in risk of developing early respiratory failure and mortality when assessed in independent models. Based upon significant correlation between FEV1 and FVC (r=0.81), FEV1 and TLC (r=0.61), FVC and TLC (r=0.80), and a lack of correlation between FEV1 and DLCO, we developed a pretransplant lung function score based upon pretransplant FEV1 and DLCO to determine the extent of pulmonary compromise prior to transplant. Multivariate analysis indicated that higher pretransplant lung function scores are associated with a significant increased risk for developing early respiratory failure (category II hazard ratio [HR] 1.4; category III HR 2.2; category IV HR 3.1; p<0.001) and death (category II HR 1.2; category III HR 2.2; category IV HR 2.7; p<0.005). Conclusions: These results suggest that not only does compromised pretransplant lung function contribute to the risk for development of early respiratory failure and mortality, this risk may be estimated prior to transplant by grading the extent of FEV1 and DLCO compromise. Key words: pretransplant pulmonary function tests, respiratory failure, mortality, bone marrow transplantation
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