Prognostic value of bronchiolitis obliterans syndrome stage 0-p in single-lung transplant recipients.
BACKGROUND
Early diagnosis of bronchiolitis obliterans syndrome (BOS) is critical in understanding pathogenesis and devising therapeutic trials. Although potential-BOS stage (BOS 0-p), encompassing early changes in FEV(1) and forced expiratory flow, midexpiratory phase (FEF(25-75%)), has been proposed, there is a paucity of data validating its utility in single-lung transplantation.


OBJECTIVE
The aim of this study was to define the predictive ability of BOS 0-p in single-lung transplantation.


METHODS
We retrospectively analyzed spirometric data for 197 single-lung recipients. Sensitivity, specificity, and positive predictive value of BOS 0-p were examined over time using Kaplan-Meier methodology.


RESULTS
BOS 0-p FEV(1) was associated with higher sensitivity, specificity, and positive predictive value than the FEF(25-75%) criterion over different time periods investigated. The probability of testing positive for BOS 0-p FEV(1) in patients with BOS (sensitivity) was 71% at 2 years before the onset of BOS. The probability of being free from development of BOS 0-p FEV(1) in patients free of BOS at follow-up (specificity) was 93% within the last year. Of patients who met the BOS 0-p FEV(1) criterion, 81% developed BOS or died within 3 years. The specificity and positive predictive value curves for the BOS 0-p FEV(1) were significantly different between patients with underlying restrictive versus obstructive physiology (p = 0.05 and 0.01, respectively).


CONCLUSIONS
The FEV(1) criterion for BOS 0-p provides useful predictive information regarding the risk of development of BOS or death in single-lung recipients. The predictive value of this criterion is higher in patients with underlying restriction and is superior to the FEF(25-75%) criterion.
Lama
Vibha N
VN
Division of Pulmonary and Critical Care Medicine, Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, 48109-0360, USA. vlama@umich.edu
Murray
Susan
S
Mumford
Jeanette A
JA
Flaherty
Kevin R
KR
Chang
Andrew
A
Toews
Galen B
GB
Peters-Golden
Marc
M
Martinez
Fernando J
FJ
D001989:Bronchiolitis Obliterans / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D005541:Forced Expiratory Volume; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013147:Spirometry; D013577:Syndrome