Brochodilator (BD) response is frequently requested in lung transplant patients. In earlier studies, bronchial hyperreactivity, as determined by BD response and methacholine challenge, has been shown to correlate with the development of Bronchiolitis Obliterans (BO) and BO Syndrome (BOS), however, these studies were limited by small sample size, small numbers of single lung transplants (SLT) and the evolution of transplant medicine since completion. We reviewed data to determine if BD response predicts BOS in single and double lung transplants.
Data from 432 patients, transplanted from 1991-2005, were reviewed. Exclusion criteria included expiration within one year of transplant, follow up less than one year and anastomotic stenosis. All patients had serial spirometry per protocol pre and post albuterol MDI. BD response was determined by current ATS guidelines. BOS was determined by decline in FEV1 as per current ISHLT criteria. Data were analyzed using the chi-squared test.
221 patients met criteria. SLT was performed in 141 (63.8%) patients. 31/221(14%) patients had a significant BD response. 12/31 (38.7%) patients in the BD responder group developed BOS vs. 45/145 (31%) of non-responders. The difference was not significant (p=0.484). In SLT, 8/24 (33%) with BD response developed BOS vs. 29/119 (24.4%) non-responders (p=0.84). There were no significant associations between BD response and single vs. double lung transplantation (p=0.394). COPD was the pre-transplant diagnosis in 12/24 SLT patients with BD response vs. 21/90 SLT patients without BD response (p=0.084).
In this study BD response was not associated with the development of BOS in DLT or SLT transplant patients. COPD was more commonly associated with BD response in SLT patients, though this difference was not significant.
BD response appears to have limited clinical utility in predicting BOS.
Forest Mealey, None.