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

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• 作者：Stijn E. Verleden ; PhD^a ; ^{stijn.verleden@med.kuleuven.be" class="auth_mail" title="E-mail the corresponding author} ; David Ruttens ; MD^a ; Elly Vandermeulen ; Ir^a ; Hannelore Bellon ; Ir^a ; Adriana Dubbeldam ; MD^b ; Walter De Wever ; MD ; PhD^b ; Lieven J. Dupont ; MD ; PhD^a ; Dirk E. Van Raemdonck ; MD ; PhD^a ; Bart M. Vanaudenaerde ; PhD^a ; Geert M. Verleden ; MD ; PhD^a ; Christian Benden ; MD ; FCCP^c ; Robin Vos ; MD ; PhD^a
• 关键词：chronic lung allograft dysfunction ; computed tomography ; eosinophils ; restrictive allograft syndrome ; upper lobe fibrosis
• 刊名：Journal of Heart and Lung Transplantation
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：35
• 期：9
• 页码：1078-1084
• 全文大小：620 K

文摘

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.