Bronchiolar airflow impairment after lung transplantation: an early and common manifestation.
BACKGROUND
Bronchiolitis obliterans syndrome (BOS) is the major limitation to long-term survival after lung transplantation (LT). In this study we investigate the extent and frequency of airflow limitation after LT and its value for the diagnosis of BOS.


METHODS
Flow-volume measurements were analyzed retrospectively in 36 recipients of a bilateral LT, with a median follow-up of 32.9 months. The prevalence and onset of a decline of FEV(1), FEF(25), FEF(50), FEF(75) and MMEF(75/25) were evaluated and subsequently related to the occurrence of Grade 1 BOS.


RESULTS
Grade 1 BOS was diagnosed in 16 recipients at a median of 218 (range 88 to 1,007) days after LT. A persistent and significant decrease in FEV(1), FEF(25), FEF(50), FEF(75) and MMEF(75/25) was observed in 23, 24, 30, 32 and 29 patients, respectively. In those patients developing BOS during follow-up this decrease was determined at 147 (55 to 657), 130 (78 to 932), 110 (21 to 573), 103 (32 to 657) and 121 (32 to 657) days after LT (p < 0.0005), respectively. The respective predictive values of these parameters for the occurrence of Grade 1 BOS (within 120 days) were 88%, 60%, 50%, 35% and 41%.


CONCLUSIONS
Bronchiolar dysfunction is a common and early finding after LT. The decrease of FEV(1) in BOS is often preceded by a decrease of bronchial airflow. Airflow markers may be used as an early warning sign for the development of BOS, although their predictive values are moderate.
Ouwens
Jan Paul
JP
Department of Pulmonology, University Hospital Groningen, Groningen, The Netherlands. j.p.ouwens@mta.azg.nl
van der Mark
Thomas W
TW
Koëter
Gerard H
GH
de Boer
Wim J
WJ
Grevink
René G
RG
van der Bij
Wim
W
D000293:Adolescent; D000328:Adult; D001989:Bronchiolitis Obliterans / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D016040:Lung Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012123:Pulmonary Ventilation / Q000502:physiology