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Significance of Best Spirometry in the First Year After Bilateral Lung Transplantation: Association With 3-Year Outcomes
BACKGROUND. Spirometry is the cornerstone of monitoring allograft function after lung transplantation (LT). We sought to determine the association of variables on best spirometry during the first year after bilateral LT with 3-year posttransplant survival. METHODS. We reviewed charts of patients who...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373484/ https://www.ncbi.nlm.nih.gov/pubmed/32732851 http://dx.doi.org/10.1097/TP.0000000000003046 |
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author | Mohanka, Manish R. Kanade, Rohan Garcia, Heriberto Mahan, Luke Bollineni, Srinivas Mullins, Jessica Joerns, John Kaza, Vaidehi Torres, Fernando Zhang, Song Banga, Amit |
author_facet | Mohanka, Manish R. Kanade, Rohan Garcia, Heriberto Mahan, Luke Bollineni, Srinivas Mullins, Jessica Joerns, John Kaza, Vaidehi Torres, Fernando Zhang, Song Banga, Amit |
author_sort | Mohanka, Manish R. |
collection | PubMed |
description | BACKGROUND. Spirometry is the cornerstone of monitoring allograft function after lung transplantation (LT). We sought to determine the association of variables on best spirometry during the first year after bilateral LT with 3-year posttransplant survival. METHODS. We reviewed charts of patients who survived at least 3 months after bilateral LT (n = 157; age ± SD: 54 ± 13 y, male:female = 91:66). Best spirometry was calculated as the average of 2 highest measurements at least 3 weeks apart during the first year. Airway obstruction was defined as forced expiratory volume in 1-second (FEV(1))/forced vital capacity (FVC) ratio <0.7. Survival was compared based on the ventilatory defect and among groups based on the best FEV(1) and FVC measurements (>80%, 60%–80%, and <60% predicted). Primary outcome was 3-year survival. RESULTS. Overall, 3-year survival was 67% (n = 106). Obstructive defect was uncommon (7%) and did not have an association with 3-year survival (72% versus 67%, P = 0.7). Although one-half patients achieved an FVC>80% predicted (49%), 1 in 5 (19%) remained below 60% predicted. Irrespective of the type of ventilatory defect, survival worsened as the best FVC (% predicted) got lower (>80: 80.8%; 60–80: 63.3%; <60: 40%; P < 0.001). On multivariate logistic regression analysis, after adjusting for age, gender, transplant indication, and annual bronchoscopy findings, best FVC (% predicted) during the first year after LT was independently associated with 3-year survival. CONCLUSIONS. A significant proportion of bilateral LT patients do not achieve FVC>80% predicted. Although the type of ventilatory defect on best spirometry does not predict survival, failure to achieve FVC>80% predicted during the first year was independently associated with 3-year mortality. |
format | Online Article Text |
id | pubmed-7373484 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-73734842020-08-05 Significance of Best Spirometry in the First Year After Bilateral Lung Transplantation: Association With 3-Year Outcomes Mohanka, Manish R. Kanade, Rohan Garcia, Heriberto Mahan, Luke Bollineni, Srinivas Mullins, Jessica Joerns, John Kaza, Vaidehi Torres, Fernando Zhang, Song Banga, Amit Transplantation Original Clinical Science—General BACKGROUND. Spirometry is the cornerstone of monitoring allograft function after lung transplantation (LT). We sought to determine the association of variables on best spirometry during the first year after bilateral LT with 3-year posttransplant survival. METHODS. We reviewed charts of patients who survived at least 3 months after bilateral LT (n = 157; age ± SD: 54 ± 13 y, male:female = 91:66). Best spirometry was calculated as the average of 2 highest measurements at least 3 weeks apart during the first year. Airway obstruction was defined as forced expiratory volume in 1-second (FEV(1))/forced vital capacity (FVC) ratio <0.7. Survival was compared based on the ventilatory defect and among groups based on the best FEV(1) and FVC measurements (>80%, 60%–80%, and <60% predicted). Primary outcome was 3-year survival. RESULTS. Overall, 3-year survival was 67% (n = 106). Obstructive defect was uncommon (7%) and did not have an association with 3-year survival (72% versus 67%, P = 0.7). Although one-half patients achieved an FVC>80% predicted (49%), 1 in 5 (19%) remained below 60% predicted. Irrespective of the type of ventilatory defect, survival worsened as the best FVC (% predicted) got lower (>80: 80.8%; 60–80: 63.3%; <60: 40%; P < 0.001). On multivariate logistic regression analysis, after adjusting for age, gender, transplant indication, and annual bronchoscopy findings, best FVC (% predicted) during the first year after LT was independently associated with 3-year survival. CONCLUSIONS. A significant proportion of bilateral LT patients do not achieve FVC>80% predicted. Although the type of ventilatory defect on best spirometry does not predict survival, failure to achieve FVC>80% predicted during the first year was independently associated with 3-year mortality. Lippincott Williams & Wilkins 2019-11-18 2020-08 /pmc/articles/PMC7373484/ /pubmed/32732851 http://dx.doi.org/10.1097/TP.0000000000003046 Text en Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Original Clinical Science—General Mohanka, Manish R. Kanade, Rohan Garcia, Heriberto Mahan, Luke Bollineni, Srinivas Mullins, Jessica Joerns, John Kaza, Vaidehi Torres, Fernando Zhang, Song Banga, Amit Significance of Best Spirometry in the First Year After Bilateral Lung Transplantation: Association With 3-Year Outcomes |
title | Significance of Best Spirometry in the First Year After Bilateral Lung Transplantation: Association With 3-Year Outcomes |
title_full | Significance of Best Spirometry in the First Year After Bilateral Lung Transplantation: Association With 3-Year Outcomes |
title_fullStr | Significance of Best Spirometry in the First Year After Bilateral Lung Transplantation: Association With 3-Year Outcomes |
title_full_unstemmed | Significance of Best Spirometry in the First Year After Bilateral Lung Transplantation: Association With 3-Year Outcomes |
title_short | Significance of Best Spirometry in the First Year After Bilateral Lung Transplantation: Association With 3-Year Outcomes |
title_sort | significance of best spirometry in the first year after bilateral lung transplantation: association with 3-year outcomes |
topic | Original Clinical Science—General |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373484/ https://www.ncbi.nlm.nih.gov/pubmed/32732851 http://dx.doi.org/10.1097/TP.0000000000003046 |
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