Chest
Volume 122, Issue 4, October 2002, Pages 1168-1175
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Clinical Investigations
Is Transplant Operation Important in Determining Posttransplant Risk of Bronchiolitis Obliterans Syndrome in Lung Transplant Recipients?

https://doi.org/10.1378/chest.122.4.1168Get rights and content

Study objectives

Lung transplantation continues to be limited by the development of chronic allograft dysfunction in the form of bronchiolitis obliterans syndrome (BOS). The effect of a transplant operation on patients with BOS has not been well-studied, but patients who undergo double-lung transplantation have better long-term survival. We hypothesized that double-lung transplantation leads to decreased rates of BOS.

Methods

A retrospective review of all lung transplant recipients at our institution, surviving for > 6 months after undergoing their transplant operation. Demographic data, information on other factors leading to the development of BOS, survival information, and data on the presence and timing of BOS were collected.

Results

BOS occurred in 41.3% of the recipients (93 of 225 patients) at a median time of 4.2 years. Single-lung transplantation was associated with increased rates of BOS compared to double-lung transplantation (49.3% vs 31.7%, respectively; p = 0.007), at the time of the analysis. Single-lung and double-lung transplant recipients had different baseline characteristics, but after controlling for these factors the type of transplant remained a significant predictor of the length of time to the onset of BOS in a multivariable proportional hazard model.

Conclusions

Double-lung transplantation is associated with a reduced risk for BOS in our study population. A multicenter study with complete BOS information on all patients with a single pretransplant diagnosis would be useful to confirm the above findings. Further research is needed to determine how the type of transplant contributes to the risk for BOS.

Section snippets

Transplant Population

Two hundred eighty-two lung transplant operations were performed at Duke University Medical Center between April 1992 and June 2000. Two hundred twenty-five patients survived for > 6 months after their transplant operation and are included in this report. The 6-month period from the time of transplantation was chosen in order to minimize the effect of events that occurred in the early posttransplant period and avoid the possibility that drops in lung function were due to other causes (like

Descriptive Characteristics

The median follow-up time for the patients was 2.4 years (interquartile range, 1.5 to 4.0 years). BOS was present in 93 of 225 patients (41.3%) at the time of the analysis. The pathologic diagnosis of OB was available in only 13.9% of patients (13 of 93 patients). All of these patients had met the spirometry criteria for BOS prior to the pathologic diagnosis. The median time to BOS development was 4.2 years (interquartile range, 3.0 to 4.8 years). The rates of freedom from BOS at 1, 2, 3, 4,

Discussion

This study presents data on the development of BOS in the lung transplant population from a single institution. It found a high incidence of BOS in lung transplant recipients, as has been described in previous studies.678910111213141516171819 Approximately 40% of the patients developed BOS by 4 years after transplantation. However, the median time to BOS development was 4.2 years, which is somewhat longer than that previously reported in the literature. Our transplant population received

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