title: Lung volumes predict survival in patients with chronic lung allograft dysfunction.
abstract: Identification of disease phenotypes might improve the understanding of patients with chronic lung allograft dysfunction (CLAD). The aim of the study was to assess the impact of pulmonary restriction and air trapping by lung volume measurements at the onset of CLAD.A total of 396 bilateral lung transplant recipients were analysed. At onset, CLAD was further categorised based on plethysmography. A restrictive CLAD (R-CLAD) was defined as a loss of total lung capacity from baseline. CLAD with air trapping (AT-CLAD) was defined as an increased ratio of residual volume to total lung capacity. Outcome was survival after CLAD onset. Patients with insufficient clinical information were excluded (n=95).Of 301 lung transplant recipients, 94 (31.2%) developed CLAD. Patients with R-CLAD (n=20) and AT-CLAD (n=21), respectively, had a significantly worse survival (p<0.001) than patients with non-R/AT-CLAD. Both R-CLAD and AT-CLAD were associated with increased mortality when controlling for multiple confounding variables (hazard ratio (HR) 3.57, 95% CI 1.39-9.18; p=0.008; and HR 2.65, 95% CI 1.05-6.68; p=0.039). Furthermore, measurement of lung volumes was useful to identify patients with combined phenotypes.Measurement of lung volumes in the long-term follow-up of lung transplant recipients allows the identification of patients who are at risk for worse outcome and warrant special consideration.
authors.affiliation: Dept of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany nikolaus.kneidinger@med.uni-muenchen.de.|Both authors contributed equally.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Kneidinger
authors.affiliation: Dept of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany.|Both authors contributed equally.
authors.forename: Katrin
authors.initials: K
authors.lastname: Milger
authors.affiliation: Dept of Medical Informatics, Biometry and Epidemiology, LMU Munich, Munich, Germany.
authors.forename: Silke
authors.initials: S
authors.lastname: Janitza
authors.affiliation: Dept of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Ceelen
authors.affiliation: Dept of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Leuschner
authors.affiliation: Institute for Clinical Radiology, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany.
authors.forename: Julien
authors.initials: J
authors.lastname: Dinkel
authors.affiliation: Comprehensive Pneumology Center (CPC-M), Research Unit Lung Repair and Regeneration, Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich, Germany.
authors.forename: Melanie
authors.identifier: 0000-0001-9414-5128
authors.initials: M
authors.lastname: Königshoff
authors.affiliation: Dept of Anaesthesiology, University of Munich, Munich, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Weig
authors.affiliation: Clinic of Cardiac Surgery, University of Munich, Munich, Germany.
authors.forename: René
authors.initials: R
authors.lastname: Schramm
authors.affiliation: Dept of Thoracic Surgery, University of Munich, Munich, Germany.
authors.forename: Hauke
authors.initials: H
authors.lastname: Winter
authors.affiliation: Dept of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Behr
authors.affiliation: Dept of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Neurohr
mesh_terms: D000328:Adult; D017963:Azithromycin / Q000627:therapeutic use; D001989:Bronchiolitis Obliterans / Q000188:drug therapy / Q000503:physiopathology*; D002908:Chronic Disease; D005260:Female; D005858:Germany; D006801:Humans; D008168:Lung / Q000503:physiopathology / Q000601:surgery; D016040:Lung Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D055031:Primary Graft Dysfunction / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013990:Tidal Volume; D014184:Transplantation, Homologous
chemical_list: D017963:Azithromycin