An association of particulate air pollution and traffic exposure with mortality after lung transplantation in Europe.
Air pollution from road traffic is a serious health risk, especially for susceptible individuals. Single-centre studies showed an association with chronic lung allograft dysfunction (CLAD) and survival after lung transplantation, but there are no large studies.13 lung transplant centres in 10 European countries created a cohort of 5707 patients. For each patient, we quantified residential particulate matter with aerodynamic diameter ≤10 µm (PM10) by land use regression models, and the traffic exposure by quantifying total road length within buffer zones around the home addresses of patients and distance to a major road or freeway.After correction for macrolide use, we found associations between air pollution variables and CLAD/mortality. Given the important interaction with macrolides, we stratified according to macrolide use. No associations were observed in 2151 patients taking macrolides. However, in 3556 patients not taking macrolides, mortality was associated with PM10(hazard ratio 1.081, 95% CI 1.000-1.167); similarly, CLAD and mortality were associated with road lengths in buffers of 200-1000 and 100-500 m, respectively (hazard ratio 1.085- 1.130). Sensitivity analyses for various possible confounders confirmed the robustness of these associations.Long-term residential air pollution and traffic exposure were associated with CLAD and survival after lung transplantation, but only in patients not taking macrolides.
KU Leuven, Leuven, Belgium.|These authors contributed equally to this paper.
David
D
Ruttens
KU Leuven, Leuven, Belgium.|These authors contributed equally to this paper.
Stijn E
SE
Verleden
Hasselt University, Hasselt, Belgium.
Esmée M
EM
Bijnens
Hasselt University, Hasselt, Belgium.
Ellen
E
Winckelmans
Hannover Medical School, Hannover, Germany.
Jens
J
Gottlieb
Hannover Medical School, Hannover, Germany.
Gregor
G
Warnecke
Universita degli Studi di Pavia, Pavia, Italy.
Federica
F
Meloni
Universita degli Studi di Pavia, Pavia, Italy.
Monica
M
Morosini
University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Wim
W
Van Der Bij
University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Erik A
EA
Verschuuren
Ruhrlandklinik, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
Urte
U
Sommerwerck
Ruhrlandklinik, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
Gerhard
G
Weinreich
Ruhrlandklinik, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
Markus
M
Kamler
Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.|CIBER Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
Antonio
A
Roman
Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.|CIBER Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
Susana
S
Gomez-Olles
Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Cristina
C
Berastegui
University Hospital Zurich, Zurich, Switzerland.
Christian
C
Benden
University of Oslo, Oslo, Norway.|Dept of Respiratory Medicine, Oslo University Hospital, Oslo, Norway.
Are Martin
AM
Holm
Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Martin
M
Iversen
Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Hans Henrik
HH
Schultz
University Medical Center Utrecht/St Antonius Hospital Nieuwegein, Utrecht, The Netherlands.
Bart
B
Luijk
University Medical Center Utrecht/St Antonius Hospital Nieuwegein, Utrecht, The Netherlands.
Erik-Jan
EJ
Oudijk
University Medical Center Utrecht/St Antonius Hospital Nieuwegein, Utrecht, The Netherlands.
Johanna M
JM
Kwakkel-van Erp
University of Vienna, Vienna, Austria.
Peter
P
Jaksch
University of Vienna, Vienna, Austria.
Walter
W
Klepetko
Klinikum Großhadern der LMU, Munich, Germany.
Nikolaus
N
Kneidinger
Klinikum Großhadern der LMU, Munich, Germany.
Claus
C
Neurohr
Newcastle University, Newcastle, UK.
Paul
P
Corris
Newcastle University, Newcastle, UK.
Andrew J
AJ
Fisher
Newcastle University, Newcastle, UK.
James
J
Lordan
Newcastle University, Newcastle, UK.
Gerard
G
Meachery
KU Leuven, Leuven, Belgium.|Universita degli Studi di Pavia, Pavia, Italy.
Davide
D
Piloni
KU Leuven, Leuven, Belgium.
Elly
E
Vandermeulen
KU Leuven, Leuven, Belgium.
Hannelore
H
Bellon
Universitätsklinikum Düsseldorf, Dusseldorf, Germany.
Barbara
B
Hoffmann
Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
Danielle
D
Vienneau
University Medical Center Utrecht/St Antonius Hospital Nieuwegein, Utrecht, The Netherlands.
Gerard
G
Hoek
Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
Kees
K
de Hoogh
KU Leuven, Leuven, Belgium.
Benoit
B
Nemery
KU Leuven, Leuven, Belgium.
Geert M
GM
Verleden
KU Leuven, Leuven, Belgium.
Robin
R
Vos
Hasselt University, Hasselt, Belgium.
Tim S
TS
Nawrot
KU Leuven, Leuven, Belgium bart.vanaudenaerde@med.kuleuven.be.
Bart M
BM
Vanaudenaerde
D000328:Adult; D000393:Air Pollutants / Q000032:analysis; D000397:Air Pollution / Q000009:adverse effects*; D015331:Cohort Studies; D004781:Environmental Exposure / Q000009:adverse effects*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006085:Graft Survival; D006801:Humans; D016040:Lung Transplantation / Q000401:mortality*; D018942:Macrolides / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D052638:Particulate Matter / Q000032:analysis; D055031:Primary Graft Dysfunction / Q000503:physiopathology*; D016016:Proportional Hazards Models; D012044:Regression Analysis
D000393:Air Pollutants; D018942:Macrolides; D052638:Particulate Matter