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Acute cellular rejection is a risk factor for bronchiolitis obliterans syndrome independent of post-transplant baseline FEV1.
J Heart Lung Transplant. 2009 Sep; 28(9):888-93.JH

Abstract

BACKGROUND

Post-transplant baseline forced expiratory volume in 1 second (FEV(1)) constitutes a systematic bias in analyses of bronchiolitis obliterans syndrome (BOS). This retrospective study evaluates risk factors for BOS adjusting for the confounding of post-transplant baseline FEV(1).

METHODS

A multivariate survival and competing risk analysis of a large consecutive series of patients (n = 389) from a national center 1992 to 2004. Exclusion criteria were patients not surviving at least 3 months after transplantation (n = 39) and no available lung function measurements (n = 4).

RESULTS

The first maximum FEV(1) occurred at a median 183 days post-transplant. Freedom from BOS was 81%, 53%, 38% and 15%, and cumulative incidence of BOS was 18%, 43%, 57% and 77% at 1, 3, 5 and 10 years post-transplantation, respectively. Acute cellular rejection was independently associated with an increased cause-specific hazard of BOS (hazard ratio 1.4, confidence interval 1.1 to 1.8, p = 0.009). The absolute value of baseline FEV(1) was a significant confounder in all survival and competing risk analyses of BOS (p < 0.05).

CONCLUSION

Despite early diagnosis and prompt treatment, acute cellular rejection remains an independent risk factor for the development of BOS after adjusting for the confounding of post-transplant baseline FEV(1).

Authors+Show Affiliations

Department of Cardiology, Division of Lung Transplantation, 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
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19716040

Citation

Burton, Christopher M., et al. "Acute Cellular Rejection Is a Risk Factor for Bronchiolitis Obliterans Syndrome Independent of Post-transplant Baseline FEV1." The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, vol. 28, no. 9, 2009, pp. 888-93.
Burton CM, Iversen M, Carlsen J, et al. Acute cellular rejection is a risk factor for bronchiolitis obliterans syndrome independent of post-transplant baseline FEV1. J Heart Lung Transplant. 2009;28(9):888-93.
Burton, C. M., Iversen, M., Carlsen, J., Mortensen, J., Andersen, C. B., Steinbrüchel, D., & Scheike, T. (2009). Acute cellular rejection is a risk factor for bronchiolitis obliterans syndrome independent of post-transplant baseline FEV1. The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, 28(9), 888-93. https://doi.org/10.1016/j.healun.2009.04.022
Burton CM, et al. Acute Cellular Rejection Is a Risk Factor for Bronchiolitis Obliterans Syndrome Independent of Post-transplant Baseline FEV1. J Heart Lung Transplant. 2009;28(9):888-93. PubMed PMID: 19716040.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute cellular rejection is a risk factor for bronchiolitis obliterans syndrome independent of post-transplant baseline FEV1. AU - Burton,Christopher M, AU - Iversen,Martin, AU - Carlsen,Jørn, AU - Mortensen,Jann, AU - Andersen,Claus B, AU - Steinbrüchel,Daniel, AU - Scheike,Thomas, PY - 2008/10/10/received PY - 2009/03/01/revised PY - 2009/04/10/accepted PY - 2009/9/1/entrez PY - 2009/9/1/pubmed PY - 2010/1/12/medline SP - 888 EP - 93 JF - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation JO - J Heart Lung Transplant VL - 28 IS - 9 N2 - BACKGROUND: Post-transplant baseline forced expiratory volume in 1 second (FEV(1)) constitutes a systematic bias in analyses of bronchiolitis obliterans syndrome (BOS). This retrospective study evaluates risk factors for BOS adjusting for the confounding of post-transplant baseline FEV(1). METHODS: A multivariate survival and competing risk analysis of a large consecutive series of patients (n = 389) from a national center 1992 to 2004. Exclusion criteria were patients not surviving at least 3 months after transplantation (n = 39) and no available lung function measurements (n = 4). RESULTS: The first maximum FEV(1) occurred at a median 183 days post-transplant. Freedom from BOS was 81%, 53%, 38% and 15%, and cumulative incidence of BOS was 18%, 43%, 57% and 77% at 1, 3, 5 and 10 years post-transplantation, respectively. Acute cellular rejection was independently associated with an increased cause-specific hazard of BOS (hazard ratio 1.4, confidence interval 1.1 to 1.8, p = 0.009). The absolute value of baseline FEV(1) was a significant confounder in all survival and competing risk analyses of BOS (p < 0.05). CONCLUSION: Despite early diagnosis and prompt treatment, acute cellular rejection remains an independent risk factor for the development of BOS after adjusting for the confounding of post-transplant baseline FEV(1). SN - 1557-3117 UR - https://www.unboundmedicine.com/medline/citation/19716040/Acute_cellular_rejection_is_a_risk_factor_for_bronchiolitis_obliterans_syndrome_independent_of_post_transplant_baseline_FEV1_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1053-2498(09)00244-7 DB - PRIME DP - Unbound Medicine ER -