Published ahead of print on March 8, 2007, doi:10.1164/rccm.200609-1344OC Am. J. Respir. Crit. Care Med., Volume 175, Number 11, June 2007, 1192-1198 A more recent version of this article appeared on June 1, 2007
Submitted on September 19, 2006 Course of FEV1 After Onset of Bronchiolitis Obliterans Syndrome in 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 Section of Thoracic Surgery, University of Michigan Health System, Ann Arbor, MI, USA, 4 Department of Pathology, University of Michigan Health System, Ann Arbor, MI, USA * To whom correspondence should be addressed. 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 trajectories were studied in 111 lung transplant recipients with BOS by multivariate linear mixed-effects statistical models. Results: FEV1 % predicted 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% predicted 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 pre-transplant diagnosis of idiopathic pulmonary fibrosis were associated with steeper decline in FEV1% predicted in the first 6 months after BOS diagnosis (p=0.02 and 0.04). 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 % predicted at BOS onset (p<0.0001), steeper decline in the first 6 months (p=0.03) and lower FEV1 % predicted at 2 years after onset (p=0.0002). Conclusion: Rapid onset of BOS, female gender, pre-transplant diagnosis of idiopathic pulmonary fibrosis and single lung transplantation are associated with worse pulmonary function after BOS onset. Key words: pulmonary function; prognosis; FEV1; bronchiolitis obliterans syndrome
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