SESSION TYPE: Lung Transplantation
PRESENTED ON: Monday, October 22, 2012 at 11:15 AM - 12:30 PM
PURPOSE: We sought to determine the correlation between a decline in FEV1 and subsequent rejection, pneumonia, or infection in patients enrolled in a home spirometry monitoring program.
METHODS: With approval of the Mayo Clinic IRB, we retrospectively reviewed records of 89 consenting consecutive lung transplant recipients (single, double, or heart-lung) from 9/26/02 until 6/12/10. We excluded those who survived less than 3 months post-transplant. All episodes of lung allograft rejection (ISHLT Grades A through D) and pneumonia (biopsy-proven and clinically diagnosed) were recorded as separate clinical events. For patients who experienced multiple events of a given type, we analyzed the time to the first event. We estimated the cumulative percentage of patients who experienced events using the Kaplan-Meier method. To assess whether a decline in FEV1 was predictive of a subsequent rejection event, we performed a proportional hazards regression analysis using the decline in FEV1 modeled as a non-reversible binary time dependent covariate.
RESULTS: Decline in FEV1 was associated with ISHLT Grade B rejection (hazard ratio = 2.98, 95% C.I. 0.99-8.93, p=0.052). Curiously, the association of FEV1 decline with ISHLT Grade A rejection demonstrated a hazard ratio of 0.48 (95% C.I. 0.26-1.03, p=0.062). The association with clinically diagnosed pneumonia was small and not statistically significant (hazard ratio = 1.26, 95% C.I. 0.50-3.18, p=0.630). We found no association with other rejection grades, organizing pneumonia, or infection. At 5 years, 56% (95% C.I. 40-67%), 36% (95% C.I. 20-49%), and 29% (95% C.I. 16-40%) of patients experienced 1 or more episodes of rejection, ISHLT Grade A or Grade B, or pneumonia (clinically diagnosed), respectively.
CONCLUSIONS: A decline in FEV1 facilitates diagnosis of ISHLT Grade B rejection. The lack of a predictive relationship between FEV1 and other ISHLT grades is unexplained by our data. A positive correlation with a clinical diagnosis of pneumonia was suggested.
CLINICAL IMPLICATIONS: A home spirometry program may facilitate early detection and treatment of acute lung rejection, thus helping to prevent irreversible graft injury.
DISCLOSURE: The following authors have nothing to disclose: Kanae Mukai, Cassie Kennedy, Darrell Schroeder, Carl Mottram, Kenneth Parker, John Scott, Sheila Alrick, Andrew Hanson, Paul Scanlon
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