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Predictors of survival in restrictive chronic lung allograft dysfunction after lung transplantation


Verleden, Stijn E; Ruttens, David; Vandermeulen, Elly; Bellon, Hannelore; Dubbeldam, Adriana; De Wever, Walter; Dupont, Lieven J; Van Raemdonck, Dirk E; Vanaudenaerde, Bart M; Verleden, Geert M; Benden, Christian; Vos, Robin (2016). Predictors of survival in restrictive chronic lung allograft dysfunction after lung transplantation. Journal of Heart and Lung Transplantation, 35(9):1078-1084.

Abstract

BACKGROUND: Chronic lung allograft dysfunction (CLAD) is the main factor limiting long-term survival after lung transplantation. Besides bronchiolitis obliterans syndrome, a restrictive phenotype of CLAD (rCLAD) exists, which is associated with poor prognosis after diagnosis. However, survival determinants for rCLAD remain to be elucidated. Our aim in this study was to establish parameters predicting survival in patients with rCLAD.
METHODS: All patients diagnosed with rCLAD in 2 lung transplant centers were assessed in a retrospective manner. Various clinical parameters [demography, pulmonary function, bronchoalveolar lavage (BAL), histopathology, radiology and blood differentials] at rCLAD diagnosis were correlated with graft survival using unadjusted and adjusted analysis.
RESULTS: A total of 53 patients with rCLAD were included with a median graft survival after diagnosis of 1.1 years. Univariate analysis demonstrated that lower-lobe-dominant or diffuse infiltrates on chest computed tomography, presence of an identifiable trigger before rCLAD onset, lymphocytic bronchiolitis, increased BAL neutrophilia, increased BAL eosinophilia and increased blood eosinophils were associated with inferior graft survival after rCLAD diagnosis. Multivariate analysis confirmed the association of location of infiltrates and blood eosinophilia on graft survival.
CONCLUSION: In this study we have identified parameters associated with graft survival after rCLAD diagnosis that may be useful to predict prognosis.

Abstract

BACKGROUND: Chronic lung allograft dysfunction (CLAD) is the main factor limiting long-term survival after lung transplantation. Besides bronchiolitis obliterans syndrome, a restrictive phenotype of CLAD (rCLAD) exists, which is associated with poor prognosis after diagnosis. However, survival determinants for rCLAD remain to be elucidated. Our aim in this study was to establish parameters predicting survival in patients with rCLAD.
METHODS: All patients diagnosed with rCLAD in 2 lung transplant centers were assessed in a retrospective manner. Various clinical parameters [demography, pulmonary function, bronchoalveolar lavage (BAL), histopathology, radiology and blood differentials] at rCLAD diagnosis were correlated with graft survival using unadjusted and adjusted analysis.
RESULTS: A total of 53 patients with rCLAD were included with a median graft survival after diagnosis of 1.1 years. Univariate analysis demonstrated that lower-lobe-dominant or diffuse infiltrates on chest computed tomography, presence of an identifiable trigger before rCLAD onset, lymphocytic bronchiolitis, increased BAL neutrophilia, increased BAL eosinophilia and increased blood eosinophils were associated with inferior graft survival after rCLAD diagnosis. Multivariate analysis confirmed the association of location of infiltrates and blood eosinophilia on graft survival.
CONCLUSION: In this study we have identified parameters associated with graft survival after rCLAD diagnosis that may be useful to predict prognosis.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Pneumology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:September 2016
Deposited On:19 Jan 2017 15:16
Last Modified:02 Feb 2018 11:33
Publisher:Elsevier
ISSN:1053-2498
OA Status:Closed
Publisher DOI:https://doi.org/10.1016/j.healun.2016.03.022
PubMed ID:27212563

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