Survival after bronchiolitis obliterans syndrome among bilateral lung transplant recipients.
BACKGROUND
Despite the importance of bronchiolitis obliterans syndrome (BOS) in lung transplantation, little is known regarding the factors that influence survival after the onset of this condition, particularly among bilateral transplant recipients.


OBJECTIVE
To identify factors that influence survival after the onset of BOS among bilateral lung transplant recipients.


METHODS
The effect of demographic or clinical factors, occurring before BOS, upon survival after the onset of BOS was studied in 95 bilateral lung transplant recipient using Cox proportional hazards models.


RESULTS
Although many factors, including prior acute rejection or rejection treatments, were not associated with survival after BOS, BOS onset within 2 years of transplantation (early-onset BOS), or BOS onset grade of 2 or 3 (high-grade onset) were predictive of significantly worse survival (early onset P = 0.04; hazard ratio, 1.84; 95% confidence interval, 1.03-3.29; high-grade onset P = 0.003; hazard ratio, 2.40; 95% confidence interval, 1.34-4.32). The effects of both early onset and high-grade onset on survival persisted in multivariable analysis and after adjustment for concurrent treatments. Results suggested an interaction might exist between early onset and high-grade onset. In particular, high-grade onset of BOS, regardless of its timing after transplant, is associated with a very poor prognosis.


CONCLUSIONS
The course of BOS after bilateral lung transplantation is variable. Distinct patterns of survival after BOS are evident and related to timing or severity of onset. Further characterization of these subgroups should provide a more rational basis from which to design, stratify, and assess response in future BOS treatment trials.
Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA. ashley.finlen.copeland@duke.edu
C Ashley
CA
Finlen Copeland
Laurie D
LD
Snyder
David W
DW
Zaas
W Jackson
WJ
Turbyfill
W Austin
WA
Davis
Scott M
SM
Palmer
D000293:Adolescent; D000328:Adult; D000368:Aged; D001989:Bronchiolitis Obliterans / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006084:Graft Rejection / Q000150:complications; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D055815:Young Adult