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Impact of Forced Expiratory Volume in 1 Second (FEV1) and 6-Minute Walking Distance at 3, 6, and 12 Months and Annually on Survival and Occurrence of Bronchiolitis Obliterans Syndrome (BOS) After Lung Transplantation

Fakhro, Mohammed LU ; Ingemansson, Richard LU ; Algotsson, Lars LU and Lindstedt, Sandra LU (2017) In Annals of Transplantation 22. p.532-540
Abstract

BACKGROUND Development of bronchiolitis obliterans syndrome (BOS) is a great limitation for patient survival in lung transplantation (LTx). A curative treatment for BOS is still missing, and in terminal stages re-transplantation (Re-LTx) is the only salvation. It is possible to slow the progress of BOS if it is detected at an early stage. This might be possible by assessing pulmonary function pattern. MATERIAL AND METHODS Between 1990 and 2014, 278 patients underwent LTx at Skåne University Hospital, Sweden. Pulmonary function was followed using spirometry (FEV1) and 6-minute walking test (6MWT) measured at 3, 6, and 12 months and annually. The endpoint used was freedom from BOS (BOS grade ≤1), BOS (BOS grade ≥2), and death or Re-LTx.... (More)

BACKGROUND Development of bronchiolitis obliterans syndrome (BOS) is a great limitation for patient survival in lung transplantation (LTx). A curative treatment for BOS is still missing, and in terminal stages re-transplantation (Re-LTx) is the only salvation. It is possible to slow the progress of BOS if it is detected at an early stage. This might be possible by assessing pulmonary function pattern. MATERIAL AND METHODS Between 1990 and 2014, 278 patients underwent LTx at Skåne University Hospital, Sweden. Pulmonary function was followed using spirometry (FEV1) and 6-minute walking test (6MWT) measured at 3, 6, and 12 months and annually. The endpoint used was freedom from BOS (BOS grade ≤1), BOS (BOS grade ≥2), and death or Re-LTx. RESULTS Double-lung transplantation (DLTx) showed a hazard ratio (HR) of 0.514 (p=0.001) versus recipients who underwent single-lung transplantation (SLTx). Regarding freedom from BOS, FEV1 showed an HR of 0.597 and 6MWT an HR of 0.982 (p<0.001). Regarding combined endpoint BOS ≥2 and Re-LTx, FEV1 showed an HR of 0.618 and 6MWT an HR of 0.972 (p<0.001). CONCLUSIONS Recipients with higher FEV1 or 6MWT values had better chances of survival. Recipients with DLTx had a significant survival benefit and a protective effect against development of BOS. As the distance that the patient can walk in 6 minutes increases, risk for death or Re-LTx is significantly lower, as is incidence of developing BOS grade ≥2. Understanding changes within pulmonary function are probably key to understanding patient prognosis.

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type
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publication status
published
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in
Annals of Transplantation
volume
22
pages
9 pages
publisher
ISI
external identifiers
  • scopus:85030255704
  • wos:000409341100001
ISSN
2329-0358
DOI
10.12659/AOT.904819
language
English
LU publication?
yes
id
df307f25-7b67-46c0-95f2-73b0b7baa4ca
date added to LUP
2017-09-06 09:18:00
date last changed
2018-01-16 13:25:03
@article{df307f25-7b67-46c0-95f2-73b0b7baa4ca,
  abstract     = {<p>BACKGROUND Development of bronchiolitis obliterans syndrome (BOS) is a great limitation for patient survival in lung transplantation (LTx). A curative treatment for BOS is still missing, and in terminal stages re-transplantation (Re-LTx) is the only salvation. It is possible to slow the progress of BOS if it is detected at an early stage. This might be possible by assessing pulmonary function pattern. MATERIAL AND METHODS Between 1990 and 2014, 278 patients underwent LTx at Skåne University Hospital, Sweden. Pulmonary function was followed using spirometry (FEV1) and 6-minute walking test (6MWT) measured at 3, 6, and 12 months and annually. The endpoint used was freedom from BOS (BOS grade ≤1), BOS (BOS grade ≥2), and death or Re-LTx. RESULTS Double-lung transplantation (DLTx) showed a hazard ratio (HR) of 0.514 (p=0.001) versus recipients who underwent single-lung transplantation (SLTx). Regarding freedom from BOS, FEV1 showed an HR of 0.597 and 6MWT an HR of 0.982 (p&lt;0.001). Regarding combined endpoint BOS ≥2 and Re-LTx, FEV1 showed an HR of 0.618 and 6MWT an HR of 0.972 (p&lt;0.001). CONCLUSIONS Recipients with higher FEV1 or 6MWT values had better chances of survival. Recipients with DLTx had a significant survival benefit and a protective effect against development of BOS. As the distance that the patient can walk in 6 minutes increases, risk for death or Re-LTx is significantly lower, as is incidence of developing BOS grade ≥2. Understanding changes within pulmonary function are probably key to understanding patient prognosis.</p>},
  author       = {Fakhro, Mohammed and Ingemansson, Richard and Algotsson, Lars and Lindstedt, Sandra},
  issn         = {2329-0358},
  language     = {eng},
  month        = {09},
  pages        = {532--540},
  publisher    = {ISI},
  series       = {Annals of Transplantation},
  title        = {Impact of Forced Expiratory Volume in 1 Second (FEV1) and 6-Minute Walking Distance at 3, 6, and 12 Months and Annually on Survival and Occurrence of Bronchiolitis Obliterans Syndrome (BOS) After Lung Transplantation},
  url          = {http://dx.doi.org/10.12659/AOT.904819},
  volume       = {22},
  year         = {2017},
}