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Intra-subject variability in oscillometry correlates with acute rejection and CLAD post-lung transplant
BACKGROUND: Chronic lung allograft dysfunction (CLAD) is the major cause of death post-lung transplantation, with acute cellular rejection (ACR) being the biggest contributing risk factor. Although patients are routinely monitored with spirometry, FEV(1) is stable or improving in most ACR episodes....
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10248398/ https://www.ncbi.nlm.nih.gov/pubmed/37305133 http://dx.doi.org/10.3389/fmed.2023.1158870 |
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author | Vasileva, Anastasiia Hanafi, Nour Huszti, Ella Matelski, John Belousova, Natalia Wu, Joyce K. Y. Martinu, Tereza Ghany, Rasheed Keshavjee, Shaf Tikkanen, Jussi Cypel, Marcelo Yeung, Jonathan C. Ryan, Clodagh M. Chow, Chung-Wai |
author_facet | Vasileva, Anastasiia Hanafi, Nour Huszti, Ella Matelski, John Belousova, Natalia Wu, Joyce K. Y. Martinu, Tereza Ghany, Rasheed Keshavjee, Shaf Tikkanen, Jussi Cypel, Marcelo Yeung, Jonathan C. Ryan, Clodagh M. Chow, Chung-Wai |
author_sort | Vasileva, Anastasiia |
collection | PubMed |
description | BACKGROUND: Chronic lung allograft dysfunction (CLAD) is the major cause of death post-lung transplantation, with acute cellular rejection (ACR) being the biggest contributing risk factor. Although patients are routinely monitored with spirometry, FEV(1) is stable or improving in most ACR episodes. In contrast, oscillometry is highly sensitive to respiratory mechanics and shown to track graft injury associated with ACR and its improvement following treatment. We hypothesize that intra-subject variability in oscillometry measurements correlates with ACR and risk of CLAD. METHODS: Of 289 bilateral lung recipients enrolled for oscillometry prior to laboratory-based spirometry between December 2017 and March 2020, 230 had ≥ 3 months and 175 had ≥ 6 months of follow-up. While 37 patients developed CLAD, only 29 had oscillometry at time of CLAD onset and were included for analysis. These 29 CLAD patients were time-matched with 129 CLAD-free recipients. We performed multivariable regression to investigate the associations between variance in spirometry/oscillometry and the A-score, a cumulative index of ACR, as our predictor of primary interest. Conditional logistic regression models were built to investigate associations with CLAD. RESULTS: Multivariable regression showed that the A-score was positively associated with the variance in oscillometry measurements. Conditional logistic regression models revealed that higher variance in the oscillometry metrics of ventilatory inhomogeneity, X5, AX, and R5-19, was independently associated with increased risk of CLAD (p < 0.05); no association was found for variance in %predicted FEV(1). CONCLUSION: Oscillometry tracks graft injury and recovery post-transplant. Monitoring with oscillometry could facilitate earlier identification of graft injury, prompting investigation to identify treatable causes and decrease the risk of CLAD. |
format | Online Article Text |
id | pubmed-10248398 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-102483982023-06-09 Intra-subject variability in oscillometry correlates with acute rejection and CLAD post-lung transplant Vasileva, Anastasiia Hanafi, Nour Huszti, Ella Matelski, John Belousova, Natalia Wu, Joyce K. Y. Martinu, Tereza Ghany, Rasheed Keshavjee, Shaf Tikkanen, Jussi Cypel, Marcelo Yeung, Jonathan C. Ryan, Clodagh M. Chow, Chung-Wai Front Med (Lausanne) Medicine BACKGROUND: Chronic lung allograft dysfunction (CLAD) is the major cause of death post-lung transplantation, with acute cellular rejection (ACR) being the biggest contributing risk factor. Although patients are routinely monitored with spirometry, FEV(1) is stable or improving in most ACR episodes. In contrast, oscillometry is highly sensitive to respiratory mechanics and shown to track graft injury associated with ACR and its improvement following treatment. We hypothesize that intra-subject variability in oscillometry measurements correlates with ACR and risk of CLAD. METHODS: Of 289 bilateral lung recipients enrolled for oscillometry prior to laboratory-based spirometry between December 2017 and March 2020, 230 had ≥ 3 months and 175 had ≥ 6 months of follow-up. While 37 patients developed CLAD, only 29 had oscillometry at time of CLAD onset and were included for analysis. These 29 CLAD patients were time-matched with 129 CLAD-free recipients. We performed multivariable regression to investigate the associations between variance in spirometry/oscillometry and the A-score, a cumulative index of ACR, as our predictor of primary interest. Conditional logistic regression models were built to investigate associations with CLAD. RESULTS: Multivariable regression showed that the A-score was positively associated with the variance in oscillometry measurements. Conditional logistic regression models revealed that higher variance in the oscillometry metrics of ventilatory inhomogeneity, X5, AX, and R5-19, was independently associated with increased risk of CLAD (p < 0.05); no association was found for variance in %predicted FEV(1). CONCLUSION: Oscillometry tracks graft injury and recovery post-transplant. Monitoring with oscillometry could facilitate earlier identification of graft injury, prompting investigation to identify treatable causes and decrease the risk of CLAD. Frontiers Media S.A. 2023-05-25 /pmc/articles/PMC10248398/ /pubmed/37305133 http://dx.doi.org/10.3389/fmed.2023.1158870 Text en Copyright © 2023 Vasileva, Hanafi, Huszti, Matelski, Belousova, Wu, Martinu, Ghany, Keshavjee, Tikkanen, Cypel, Yeung, Ryan and Chow. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Medicine Vasileva, Anastasiia Hanafi, Nour Huszti, Ella Matelski, John Belousova, Natalia Wu, Joyce K. Y. Martinu, Tereza Ghany, Rasheed Keshavjee, Shaf Tikkanen, Jussi Cypel, Marcelo Yeung, Jonathan C. Ryan, Clodagh M. Chow, Chung-Wai Intra-subject variability in oscillometry correlates with acute rejection and CLAD post-lung transplant |
title | Intra-subject variability in oscillometry correlates with acute rejection and CLAD post-lung transplant |
title_full | Intra-subject variability in oscillometry correlates with acute rejection and CLAD post-lung transplant |
title_fullStr | Intra-subject variability in oscillometry correlates with acute rejection and CLAD post-lung transplant |
title_full_unstemmed | Intra-subject variability in oscillometry correlates with acute rejection and CLAD post-lung transplant |
title_short | Intra-subject variability in oscillometry correlates with acute rejection and CLAD post-lung transplant |
title_sort | intra-subject variability in oscillometry correlates with acute rejection and clad post-lung transplant |
topic | Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10248398/ https://www.ncbi.nlm.nih.gov/pubmed/37305133 http://dx.doi.org/10.3389/fmed.2023.1158870 |
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