Background

The prognostic value of evaluating spirometry at a fixed time point using standardized population reference has not previously been evaluated. Our aim was to assess the association between spirometric phenotype at 12 months (Spiro_12M), survival and incidence of chronic lung allograft dysfunction (CLAD) in bilateral lung transplant recipients.

Methods

We conducted a retrospective cohort study of bilateral lung transplant recipients transplanted between January 2003 and September 2012. We defined Spiro_12M as the mean of the 2 prebronchodilator FEV₁ measurements 12-month post-transplant. Normal spirometry was defined as FEV₁/FVC ≥0.7 and FEV1≥80% and FVC≥80% predicted population-based values for that recipient. Abnormal spirometry was defined as failure to attain normal function by 12-months. We used a Cox regression model to assess the association between Spiro_12M, survival, and CLAD. We used logistic regression to assess potential pretransplant donor and recipient factors associated with abnormal Spiro_12M

Results

One hundred and eleven (51%) lung transplant recipients normalized their Spiro_12M. Normal Spiro_12M was associated improved survival (hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.41-0.88], p = 0.009. Each 10% decrement in FEV₁ increased the risk of death in a stepwise fashion. Additionally, CLAD was reduced in those with normal Spiro_12M (HR:0.65, 95%CI:0.46-0.92, p = 0.016). Donor smoking history (OR:2.93, 95% CI:1.21-7.09; p = 0.018) and mechanical ventilation time in hours (OR:1.03, 95% CI:1.004-1.05; p = 0.02) were identified as independent predictors of abnormal Spiro_12M.

Conclusions

Abnormal Spiro_12M is associated with increased mortality and the development of CLAD. The effect is dose dependent with increased dysfunction corresponding to increased risk. This assessment of phenotype at 12-months can easily be incorporated into standard of care.

中文翻译：

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肺移植后一年肺功能异常是死亡率增加和慢性同种异体移植肺功能障碍的重要预测因素

背景

使用标准化人群参考在固定时间点评估肺活量测定的预后价值以前没有被评估过。我们的目的是评估双侧肺移植受者在 12 个月时的肺活量表型 (Spiro _{12M )、存活率和慢性同种异体肺移植物功能障碍 (CLAD) 的发生率之间的关联。}

方法

我们对 2003 年 1 月至 2012 年 9 月间移植的双侧肺移植受者进行了一项回顾性队列研究。我们将 Spiro _12M定义为移植后 12 个月的 2 次支气管扩张剂前 FEV ₁测量值的平均值。正常肺活量测定被定义为 FEV ₁ /FVC ≥0.7和FEV1 ≥80%和FVC ≥80% 预测的该接受者基于人群的值。肺功能异常被定义为在 12 个月内未能达到正常功能。我们使用 Cox 回归模型来评估 Spiro _{12M之间的关联}、 生存和 CLAD。我们使用逻辑回归来评估与异常 Spiro _{12M相关的潜在移植前供体和受体因素}

结果

111 名 (51%) 肺移植受者的 Spiro _12M正常化。正常 Spiro _12M与提高生存率相关（风险比 [HR] 0.60，95% 置信区间 [CI] 0.41-0.88]，p  = 0.009。FEV ₁每减少 10% ，死亡风险就会逐步增加。此外， Spiro _12M正常者的 CLAD 降低(HR:0.65, 95%CI:0.46-0.92, p  = 0.016)。供体吸烟史 (OR:2.93, 95% CI:1.21-7.09; p  = 0.018) 和机械通气以小时为单位的时间（OR：1.03，95% CI：1.004-1.05；p  = 0.02）被确定为 Spiro _12M异常的独立预测因子。

结论

Spiro _12M异常与死亡率增加和 CLAD 的发展有关。效果是剂量依赖性的，功能障碍增加与风险增加相对应。这种在 12 个月时对表型的评估可以很容易地纳入护理标准。