title: Bronchiolitis Obliterans Syndrome and Death in Iranian Lung Transplant Recipients: A Bayesian Competing Risks Analysis.
abstract: BACKGROUND
  Bronchiolitis obliterans syndrome (BOS) is delayed allograft deterioration after lung transplant (LTX) that is clinically characterized by ≥ 20% decline from the baseline value of forced expiratory volume during the first second (FEV1). BOS is still a major obstacle limiting long-term survival post-LTX. The main aim of this study was to determine the predictors of BOS and death in Iranian LTX recipients.
  
  
  METHODS
  This retrospective cohort study included 44 LTX recipients who survived ≥ 3 months post-LTX at the Masih Daneshvari Hospital, Tehran, Iran from 2000 to 2014. The outcome was time from lung transplantation to BOS and/or death (due to all causes except BOS). We used competing risks analysis to assess the effect of other factors on the cumulative incidence function of BOS and death. We applied a Fine and Gray model with Bayesian approach.
  
  
  RESULTS
  The recipients' age (Mean ± SD) was 36.7 ± 14.5 yr. 11 (25%) recipients developed BOS as the first event within the first five years post-LTX and 13 (30%) died due to all causes except for BOS. Our results showed that CMV infection was associated with a significant increase in risk of developing BOS [hazard ratio (HR) 1.22 (95% credible set: (1.01, 3.2)] controlling for other variables. Bilateral transplantation [HR (95% credible set): 2.4(1.51, 4.05)] and CMV infection [HR (95% credible set): 2.02 (1.67, 2.55)] were predictors of the mortality risk.
  
  
  CONCLUSIONS
  CMV infection was a predictor of BOS risk in the studied patients. Moreover, bilateral transplantation and CMV infection were significant predictors of mortality in the present sample. Multi-center studies with larger sample sizes are required to better study the other risk factors, and the pathophysiologic mechanisms of BOS.
authors.affiliation: Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
authors.forename: Fatemeh Sadat
authors.initials: FS
authors.lastname: Hosseini-Baharanchi
authors.affiliation: Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
authors.forename: Ebrahim
authors.initials: E
authors.lastname: Hajizadeh
authors.affiliation: Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Ahmad Reza
authors.initials: AR
authors.lastname: Baghestani
authors.affiliation: Lung Transplant Research Center, Masih Daneshvari Hospital, National Research Institute of Tuberculosis and Lung Disease, Tehran, Iran.
authors.forename: Katayoun
authors.initials: K
authors.lastname: Najafizadeh
authors.affiliation: Lung Transplant Research Center, Masih Daneshvari Hospital, National Research Institute of Tuberculosis and Lung Disease, Tehran, Iran.
authors.forename: Shadi
authors.initials: S
authors.lastname: Shafaghi
keywords: Bayesian analysis; Bronchiolitis obliterans syndrome; Competing risks analysis; Cumulative Incidence Function; Fine and Gray model; Lung transplant