title: The impact of traffic air pollution on bronchiolitis obliterans syndrome and mortality after lung transplantation.
abstract: BACKGROUND
  Approximately half of all patients who underwent a lung transplantation suffer from bronchiolitis obliterans syndrome (BOS), the clinical correlate of chronic rejection, within 5 years after transplantation. This prevalence is much higher than for other solid organ transplantations, possibly due to the lung's direct contact with the environment. The authors assessed the association between proximity of the home to major roads and BOS and mortality in a cohort of patients after lung transplantation.
  
  
  METHODS
  The authors calculated hazard ratios for BOS and mortality in relation to proximity of the home to major roads, adjusting for relevant covariables, in 288 patients after lung transplantation at the Leuven University Hospital between 1997 and 2009 and with follow-up until August 2009. Inflammatory parameters in plasma and bronchoalveolar lavage were assessed in 207 patients.
  
  
  RESULTS
  During follow-up, 117 (41%) patients developed BOS and 61 (21%) died. Patients who lived within 171 m of a major road (lowest tertile) were 2.06 (95% CI 1.39 to 3.05) times more likely to develop BOS and 2.20 (1.25 to 3.86) times more likely to die than patients living farther away. The adjusted hazard ratios of BOS and mortality were 0.57 and 0.72 for each 10-fold increase in distance from major roads. Proximity to a major road was inversely associated with plasma C-reactive protein levels, neutrophil percentage and interleukin-6 concentration in bronchoalveolar lavage.
  
  
  CONCLUSIONS
  Traffic-related air pollution appears to constitute a serious risk of BOS and mortality after lung transplantation.
authors.affiliation: Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium.
authors.forename: Tim S
authors.initials: TS
authors.lastname: Nawrot
authors.forename: Robin
authors.initials: R
authors.lastname: Vos
authors.forename: Lotte
authors.initials: L
authors.lastname: Jacobs
authors.forename: Stijn E
authors.initials: SE
authors.lastname: Verleden
authors.forename: Shana
authors.initials: S
authors.lastname: Wauters
authors.forename: Veerle
authors.initials: V
authors.lastname: Mertens
authors.forename: Christophe
authors.initials: C
authors.lastname: Dooms
authors.forename: Peter H
authors.initials: PH
authors.lastname: Hoet
authors.forename: Dirk E
authors.initials: DE
authors.lastname: Van Raemdonck
authors.forename: Christel
authors.initials: C
authors.lastname: Faes
authors.forename: Lieven J
authors.initials: LJ
authors.lastname: Dupont
authors.forename: Benoit
authors.initials: B
authors.lastname: Nemery
authors.forename: Geert M
authors.initials: GM
authors.lastname: Verleden
authors.forename: Bart M
authors.initials: BM
authors.lastname: Vanaudenaerde
mesh_terms: D000328:Adult; D000397:Air Pollution / Q000009:adverse effects*; D001530:Belgium / Q000453:epidemiology; D001989:Bronchiolitis Obliterans / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality*; D006801:Humans; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D018986:Motor Vehicles; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013577:Syndrome