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Spirometric Obstructive Lung Function Pattern Early After Lung Transplantation

Suhling, Hendrik1,4; Dettmer, Sabine2; Rademacher, Jessica1; Greer, Mark1; Shin, Hoen-Oh2; Tudorache, Igor3; Kühn, Christian3; Haverich, Axel3; Welte, Tobias1; Warnecke, Gregor3; Gottlieb, Jens1

doi: 10.1097/TP.0b013e31823dd670
Clinical and Translational Research

Background. An obstructive pattern in pulmonary function test is common after lung transplantation (LTx) and may be caused by multiple disorders. In this study, the impact and outcome of an obstructive spirometric pattern identified in transplant recipients early posttransplantation were investigated.

Methods. Analyzing all patients undergoing double LTx between September 1, 2007, and October 1, 2009, we separated patients with an obstructive (forced expiratory volume in 1 sec [FEV1]: vital capacity [VC] <0.7) and a nonobstructive pattern (FEV1:VC ≥0.7) in pulmonary function tests 3 months after transplantation. Pulmonary function measurement, bronchoscopy, laboratory parameter, computed tomography morphology, mortality, and bronchiolitis obliterans syndrome (BOS)-free survival were analyzed up to 36 months after transplantation. In addition, information about donor lungs were collected (age, smoking history, and blood gas before lung harvesting).

Results. From 122 recipients included, 17 (14%) exhibited an obstructive pattern. Recipients with an early obstructive pattern were older at transplantation, had significantly decreased FEV1, increased total lung capacity, and donor organ with lower pO2 when ventilated with 100% oxygen before retrieval. Obstructive patients developed their best FEV1 earlier after LTx and demonstrated a significant increase in BOS development (47% vs. 14%).

Conclusions. An obstructive lung function pattern early after LTx was associated with earlier development of BOS and may have negative impact on outcome after double LTx. Early obstructive pattern after transplantation might be an indication of structural donor lung injury.

1Department of Pulmonary Medicine, Hannover Medical School, Hannover, Germany.

2Department of Radiology, Hannover Medical School, Hannover, Germany.

3Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.

The authors declare no funding or conflict of interest.

Address correspondence to: Hendrik Suhling, M.D., Department of Respiratory Medicine, Hannover Medical School, OE6870, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany. E-mail: suhling.hendrik@mh-hannover.de

H.S. participated in research design, data analysis, writing of the manuscript; S.D. participated in writing of the manuscript and analyzed CT scans; J.R., H.-o.S., I.T., C.K., A.H., T.W., and G.W. participated in writing of the manuscript; M.G. participated in writing of the manuscript and corrections in English language; and J.G. participated in research design, data analysis, and writing of the manuscript.

Received 18 July 2011. Revision requested 16 August 2011.

Accepted 18 October 2011.

© 2012 Lippincott Williams & Wilkins, Inc.