Original article
Bronchiolar airflow impairment after lung transplantation: an early and common manifestation

https://doi.org/10.1016/S1053-2498(02)00447-3Get rights and content

Abstract

Background:

Bronchiolitis obliterans syndrome (BOS) is the major limitation to long-term survival after lung transplantation (LT). In this study we investigate the extent and frequency of airflow limitation after LT and its value for the diagnosis of BOS.

Methods:

Flow-volume measurements were analyzed retrospectively in 36 recipients of a bilateral LT, with a median follow-up of 32.9 months. The prevalence and onset of a decline of FEV1, FEF25, FEF50, FEF75 and MMEF75/25 were evaluated and subsequently related to the occurrence of Grade 1 BOS.

Results:

Grade 1 BOS was diagnosed in 16 recipients at a median of 218 (range 88 to 1007) days after LT. A persistent and significant decrease in FEV1, FEF25, FEF50, FEF75 and MMEF75/25 was observed in 23, 24, 30, 32 and 29 patients, respectively. In those patients developing BOS during follow-up this decrease was determined at 147 (55 to 657), 130 (78 to 932), 110 (21 to 573), 103 (32 to 657) and 121 (32 to 657) days after LT (p < 0.0005), respectively. The respective predictive values of these parameters for the occurrence of Grade 1 BOS (within 120 days) were 88%, 60%, 50%, 35% and 41%.

Conclusion:

Bronchiolar dysfunction is a common and early finding after LT. The decrease of FEV1 in BOS is often preceded by a decrease of bronchial airflow. Airflow markers may be used as an early warning sign for the development of BOS, although their predictive values are moderate.

Section snippets

Materials and methods

For the purpose of this study all flow-volume measurements of 36 patients were evaluated. From December 1994 to May 1998, 62 patients underwent lung transplantation at the University Hospital Groningen. Twenty-six patients were excluded: 7 recipients of a single LT; 4 patients with endoscopically significant airway pathology; 9 patients with a follow-up of <3 months after transplantation (e.g., due to early death); 5 patients with a still-increasing FEV1 after transplantation; and 1 patient

Results

The 36 patients studied were divided in patients with BOS (n = 16) and patients without BOS (n = 20) (Table I). The median follow-up of the total group was 32.9 months. The mean values of Vcoef in the non-BOS group for FEV1, FEF25, FEF50, FEF75 and MMEF75/25 were 4.0%, 7.4%, 9.8%, 14.9% and 10.7%, respectively. These values are comparable with the variation in the normal population. The lower limits of FEV1, FEF25, FEF50, FEF75 and MMEF75/25 were 93.3%, 87.9%, 84.0%, 75.6% and 82.4%,

Discussion

The present study indicates that: (1) the majority of LT recipients will eventually develop pulmonary dysfunction, as defined by all markers tested here; and (2) the diagnosis of BOS and a persistent decrease of FEV1 is preceded by persistent decreases of expiratory flow. The data described herein suggest that earlier detection of BOS is possible, using the decline of flow measurements.

Chronic lung transplant dysfunction or bronchiolitis obliterans syndrome is the most commonly noted impediment

References (17)

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