Details

Autor(en) / Beteiligte

• Sato, Masaaki, MD, PhD
• Waddell, Thomas K., MD, PhD
• Wagnetz, Ute, MD
• Roberts, Heidi C., MD
• Hwang, David M., MD, PhD
• Haroon, Ayesha, MD
• Wagnetz, Dirk, MD
• Chaparro, Cecilia, MD
• Singer, Lianne G., MD
• Hutcheon, Michael A., MD
• Keshavjee, Shaf, MD, MSc

Titel

Restrictive allograft syndrome (RAS): A novel form of chronic lung allograft dysfunction

Ist Teil von

• The Journal of heart and lung transplantation, 2011-07, Vol.30 (7), p.735-742

Ort / Verlag

New York, NY: Elsevier Inc

Erscheinungsjahr

2011

Quelle

MEDLINE

Beschreibungen/Notizen

• Background Bronchiolitis obliterans syndrome (BOS) with small-airway pathology and obstructive pulmonary physiology may not be the only form of chronic lung allograft dysfunction (CLAD) after lung transplantation. Characteristics of a form of CLAD consisting of restrictive functional changes involving peripheral lung pathology were investigated. Methods Patients who received bilateral lung transplantation from 1996 to 2009 were retrospectively analyzed. Baseline pulmonary function was taken as the time of peak forced expiratory volume in 1 second (FEV1 ). CLAD was defined as irreversible decline in FEV1 < 80% baseline. The most accurate threshold to predict irreversible decline in total lung capacity and thus restrictive functional change was at 90% baseline. Restrictive allograft syndrome (RAS) was defined as CLAD meeting this threshold. BOS was defined as CLAD without RAS. To estimate the effect on survival, Cox proportional hazards models and Kaplan-Meier analyses were used. Results Among 468 patients, CLAD developed in 156; of those, 47 (30%) showed the RAS phenotype. Compared with the 109 BOS patients, RAS patients showed significant computed tomography findings of interstitial lung disease ( p < 0.0001). Prevalence of RAS was approximately 25% to 35% of all CLAD over time. Patient survival of RAS was significantly worse than BOS after CLAD onset (median survival, 541 vs 1,421 days; p = 0.0003). The RAS phenotype was the most significant risk factor of death among other variables after CLAD onset (hazard ratio, 1.60; confidential interval, 1.23–2.07). Conclusions RAS is a novel form of CLAD that exhibits characteristics of peripheral lung fibrosis and significantly affects survival of lung transplant patients.