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Post-transplant baseline FEV1 and the development of bronchiolitis obliterans syndrome: an important confounder?
J Heart Lung Transplant. 2007 Nov; 26(11):1127-34.JH

Abstract

BACKGROUND

Because bronchiolitis obliterans syndrome (BOS) is defined and graded according to the decline in forced expiratory volume in 1 second (FEV(1)) relative to a maximal baseline value obtained post-transplantation, the criteria discriminates against recipients with lower maximal baseline values (i.e., constitutes a statistical bias). This study describes the effect of transplant procedure on the development of BOS, adjusting for the absolute value of post-transplant baseline FEV(1).

METHODS

All patients receiving a cadaveric lung transplant from 1992 to 2004 were included in the study (n = 389). Exclusion criteria were patients surviving <3 months (n = 39) and missing spirometry measurements (n = 4).

RESULTS

Baseline FEV(1) was strongly associated with the freedom from BOS Grade 1, and longer-duration BOS-free survival in univariate and multivariate survival analyses. After adjusting for baseline FEV(1), and recipient-donor gender, bilateral lung transplantation (BLT) was associated with an increase in the cause-specific risk of BOS Grade 1 (hazard ratio [HR] 2.0, confidence interval [CI] 1.2 to 3.1, p = 0.004), and an increase in the cause-specific risk of death/re-transplantation or BOS Grade 1 as a combined end-point (HR 2.3, CI 1.5 to 3.4, p < 0.0001) compared with single-lung transplantation (SLT). In the competing risk regression model adjusting for recipient-donor gender and transplant procedure, only baseline FEV(1) remained independently associated with the cumulative incidence of BOS Grade 1 (p < 0.05); however, BLT recipients were more likely to have death/re-transplantation unrelated to BOS than SLT recipients.

CONCLUSIONS

The absolute value of baseline lung function appears to be an important confounder in the analyses of BOS, and should be considered in future risk factor analyses.

Authors+Show Affiliations

Department of Cardiology, Division of Lung Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. cmburton@doctors.net.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18022078

Citation

Burton, Christopher M., et al. "Post-transplant Baseline FEV1 and the Development of Bronchiolitis Obliterans Syndrome: an Important Confounder?" The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, vol. 26, no. 11, 2007, pp. 1127-34.
Burton CM, Iversen M, Mortensen J, et al. Post-transplant baseline FEV1 and the development of bronchiolitis obliterans syndrome: an important confounder? J Heart Lung Transplant. 2007;26(11):1127-34.
Burton, C. M., Iversen, M., Mortensen, J., Carlsen, J., Andersen, C. B., Milman, N., & Scheike, T. (2007). Post-transplant baseline FEV1 and the development of bronchiolitis obliterans syndrome: an important confounder? The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, 26(11), 1127-34.
Burton CM, et al. Post-transplant Baseline FEV1 and the Development of Bronchiolitis Obliterans Syndrome: an Important Confounder. J Heart Lung Transplant. 2007;26(11):1127-34. PubMed PMID: 18022078.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Post-transplant baseline FEV1 and the development of bronchiolitis obliterans syndrome: an important confounder? AU - Burton,Christopher M, AU - Iversen,Martin, AU - Mortensen,Jann, AU - Carlsen,Jørn, AU - Andersen,Claus B, AU - Milman,Nils, AU - Scheike,Thomas, Y1 - 2007/09/29/ PY - 2007/05/07/received PY - 2007/07/27/revised PY - 2007/07/27/accepted PY - 2007/11/21/pubmed PY - 2008/3/12/medline PY - 2007/11/21/entrez SP - 1127 EP - 34 JF - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation JO - J Heart Lung Transplant VL - 26 IS - 11 N2 - BACKGROUND: Because bronchiolitis obliterans syndrome (BOS) is defined and graded according to the decline in forced expiratory volume in 1 second (FEV(1)) relative to a maximal baseline value obtained post-transplantation, the criteria discriminates against recipients with lower maximal baseline values (i.e., constitutes a statistical bias). This study describes the effect of transplant procedure on the development of BOS, adjusting for the absolute value of post-transplant baseline FEV(1). METHODS: All patients receiving a cadaveric lung transplant from 1992 to 2004 were included in the study (n = 389). Exclusion criteria were patients surviving <3 months (n = 39) and missing spirometry measurements (n = 4). RESULTS: Baseline FEV(1) was strongly associated with the freedom from BOS Grade 1, and longer-duration BOS-free survival in univariate and multivariate survival analyses. After adjusting for baseline FEV(1), and recipient-donor gender, bilateral lung transplantation (BLT) was associated with an increase in the cause-specific risk of BOS Grade 1 (hazard ratio [HR] 2.0, confidence interval [CI] 1.2 to 3.1, p = 0.004), and an increase in the cause-specific risk of death/re-transplantation or BOS Grade 1 as a combined end-point (HR 2.3, CI 1.5 to 3.4, p < 0.0001) compared with single-lung transplantation (SLT). In the competing risk regression model adjusting for recipient-donor gender and transplant procedure, only baseline FEV(1) remained independently associated with the cumulative incidence of BOS Grade 1 (p < 0.05); however, BLT recipients were more likely to have death/re-transplantation unrelated to BOS than SLT recipients. CONCLUSIONS: The absolute value of baseline lung function appears to be an important confounder in the analyses of BOS, and should be considered in future risk factor analyses. SN - 1557-3117 UR - https://www.unboundmedicine.com/medline/citation/18022078/Post_transplant_baseline_FEV1_and_the_development_of_bronchiolitis_obliterans_syndrome:_an_important_confounder L2 - https://linkinghub.elsevier.com/retrieve/pii/S1053-2498(07)00603-1 DB - PRIME DP - Unbound Medicine ER -