JHLT open · 2026
Ventilation heterogeneity early post lung transplant as a marker of future bronchiolitis obliterans syndrome and mortality - A 10 year study.
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Thompson Bruce R, Ellis Matthew J, Matsas Pam, Verbanck Sylvia, Snell Greg I
Аннотация
UNLABELLED: Lung transplantation (LTx) is regarded as an effective treatment of end-stage lung disease, yet recipients are at significant risk of developing Bronchiolitis Obliterans Syndrome (BOS). Previous studies have shown that BOS is related to ventilatory heterogeneity, IL-8 and airway hyper-responsiveness (AHR). What has been less explored is the potential for these measures taken early post-LTx to predict future BOS or death.
METHODS: Double LTx patients had spirometry, and measures of acinar (Sacin) and conductive (Scond) ventilation heterogeneity from the multiple breath nitrogen washout (MBNW) at regular intervals over a 12month period. AHR was also measured within 6 months of LTx and IL-8 was estimated from bronchoalveolar lavage taken at the time of pulmonary function measures. Patients were further monitored for BOS or death during a 10-year follow-up period.
RESULTS: Of the 33 patients recruited, 17 patients developed BOS, and 13 died over the follow-up period. The patients who had an Scond > 0.029 L-1 in the first 6 months post-LTx had a hazard ratio of 5.1 (P=0.0022) for BOS/ Death. Also, patients with a Log IL-8 > 3.1 pg/mL in the first 6 months had a hazard ratio of 2.8 (P=0.039) for BOS/Death. The patients with Scond or IL-8 in excess of their respective threshold amounted to a hazard ratio of 3.7 (P=0.0085). Finally, a hypertonic saline dose response slope>0.25Δ%FEV1/mL was not predictive of BOS/Death.
CONCLUSION: We have demonstrated that increased Scond or IL-8 within 6-month post LTx is associated with greatly increased risk of BOS according to the 2001 definition or death within 10 years. Restrictive Allograft Syndrome cannot not be fully excluded due to the absence of routine static lung volume measurements.
METHODS: Double LTx patients had spirometry, and measures of acinar (Sacin) and conductive (Scond) ventilation heterogeneity from the multiple breath nitrogen washout (MBNW) at regular intervals over a 12month period. AHR was also measured within 6 months of LTx and IL-8 was estimated from bronchoalveolar lavage taken at the time of pulmonary function measures. Patients were further monitored for BOS or death during a 10-year follow-up period.
RESULTS: Of the 33 patients recruited, 17 patients developed BOS, and 13 died over the follow-up period. The patients who had an Scond > 0.029 L-1 in the first 6 months post-LTx had a hazard ratio of 5.1 (P=0.0022) for BOS/ Death. Also, patients with a Log IL-8 > 3.1 pg/mL in the first 6 months had a hazard ratio of 2.8 (P=0.039) for BOS/Death. The patients with Scond or IL-8 in excess of their respective threshold amounted to a hazard ratio of 3.7 (P=0.0085). Finally, a hypertonic saline dose response slope>0.25Δ%FEV1/mL was not predictive of BOS/Death.
CONCLUSION: We have demonstrated that increased Scond or IL-8 within 6-month post LTx is associated with greatly increased risk of BOS according to the 2001 definition or death within 10 years. Restrictive Allograft Syndrome cannot not be fully excluded due to the absence of routine static lung volume measurements.