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Validation of a post-transplant chronic lung allograft dysfunction classification system.
- Source :
-
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation [J Heart Lung Transplant] 2019 Feb; Vol. 38 (2), pp. 166-173. Date of Electronic Publication: 2018 Oct 04. - Publication Year :
- 2019
-
Abstract
- Background: Long-term survival after lung transplantation (LTx) is hampered by chronic lung allograft dysfunction (CLAD). Our study evaluated the prevalence and prognostic importance of obstructive and restrictive CLAD phenotypes, with or without an identifiable underlying cause, to validate the recently proposed classification system for CLAD.<br />Methods: Data for patients who underwent LTx between 2004 and 2015 with a minimal survival of 180 days post-LTx were retrospectively collected. Double LTx patients with CLAD (defined as a persistent forced expiratory volume in 1 second decline of ≥ 20% compared with baseline) were subsequently classified according to obstructive (forced expiratory volume in 1 second /forced vital capacity [FVC] < 70%, total lung capacity > 90%, and FVC > 80%) or restrictive (total lung capacity ≤ 90% or FVC ≤ 80%) pulmonary function and to the presence of an unknown (bronchiolitis obliterans syndrome [BOS]/restrictive allograft syndrome [RAS]) or known (non-BOS/non-RAS) underlying cause.<br />Results: After a median of 3.2 years, CLAD developed in 39% of double LTx patients (n = 219), of which 20% (n = 43) had an identifiable cause. Survival was worse in patients with restrictive CLAD (26%) compared with obstructive CLAD (64%; p < 0.0001). Non-BOS patients suffered from inferior survival compared with BOS patients (p = 0.0016), whereas there was no significant difference in survival between RAS and non-RAS (p = 0.17). Patients who evolved from an obstructive (BOS) to a restrictive (RAS) phenotype (10%) experienced better survival than RAS patients and a worse outcome compared with BOS patients (p < 0.0001).<br />Conclusions: Given the differences in outcome, accurate diagnosis of CLAD phenotypes is important, because this helps to inform patients about their prognosis, to reveal underlying pathogenesis, to identify homogenous patient populations for clinical trials, and to guide future therapeutic approaches.<br /> (Copyright © 2018 Elsevier Ltd. All rights reserved.)
- Subjects :
- Adult
Allografts
Belgium epidemiology
Chronic Disease
Female
Follow-Up Studies
Humans
Male
Middle Aged
Prevalence
Primary Graft Dysfunction epidemiology
Primary Graft Dysfunction physiopathology
Prognosis
ROC Curve
Retrospective Studies
Risk Factors
Survival Rate trends
Total Lung Capacity
Young Adult
Lung physiopathology
Lung Transplantation adverse effects
Primary Graft Dysfunction classification
Subjects
Details
- Language :
- English
- ISSN :
- 1557-3117
- Volume :
- 38
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 30391199
- Full Text :
- https://doi.org/10.1016/j.healun.2018.09.020