Impact of Lung Function Decline on Mortality in Lung Transplant Recipients: Long-Term Results From the L-CsA-i Study for the Prevention of Bronchiolitis Obliterans Syndrome.

Fecha de publicación: 01/01/2022 Fecha Ahead of Print: 02/06/2022

Autores de IIS La Fe

Amparo Solé Jover

Autor

Participantes ajenos a IIS La Fe

Kneidinger, Nikolaus
Ghiani, Alessandro
Milger, Katrin
Monforte, Victor
Knoop, Christiane
Jaksch, Peter
Parmar, Jasvir
Ussetti, Piedad
Müller-Quernheim J
Voelp, Andreas
Behr, Juergen
Neurohr, Claus

Grupos

Infección Grave

Investigador Principal

María Ángeles Tormo Mas

Abstract

BackgroundChronic lung allograft dysfunction (CLAD) is defined by a progressive loss of FEV1 and is associated with premature mortality. The aim of this study was to investigate the direct association between FEV1 decline and risk of mortality in patients after lung transplantation (LTx). Methods10-year follow up data from lung transplant recipients participating in randomized placebo-controlled clinical trial investigating the role of liposomal Cyclosporine A for inhalation (L-CsA-i) in the prevention of bronchiolitis obliterans syndrome (NCT01334892) was used. The association between the course of FEV1 over time and the risk of mortality was assessed using joint modeling and Cox regression analysis. ResultsA total of 130 patients were included. Predictors of FEV1 decline were a higher absolute FEV1 at baseline and male sex. The joint model analysis indicated a significant association of change of FEV1 and risk of mortality (p < 0.001), with a predicted 3.4% increase in mortality risk for each 1% decline in FEV1. Significant predictors of a progressive phenotype were single LTx and treatment with placebo (as opposed to L-CsA-i). At the end of follow-up, 82 patients (63.1%) were still alive. Cox regression analyses for mortality identified only single LTx as a predictor of higher risk. ConclusionBased on our observation of a close association between FEV1 and mortality over a period of 10 years we suggest FEV1 as a valid predictor of mortality and a suitable surrogate endpoint in the investigation of early interventions.

Datos de la publicación

ISSN/ISSNe:: 2296-858X, 2296-858X
Tipo:: Article
Páginas:: 897581-897581
DOI:: 10.3389/fmed.2022.897581
Factor de Impacto:: 1,179 SCImago ℠
Cuartil:: Q1 SCImago ℠

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Filiaciones

Kneidinger, Nikolaus:: Department of Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
Ghiani, Alessandro:: Department of Pulmonology and Respiratory Medicine, Robert-Bosch-Hospital, Stuttgart, Germany
Milger, Katrin:: Department of Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
Monforte, Victor:: Hospital Universitari Vall d'Hebron, Barcelona, Spain
Knoop, Christiane:: CHU Erasme Université Libre de Bruxelles, Brussel, Belgium
Jaksch, Peter:: Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
Parmar, Jasvir:: Royal Papworth Hospital, Cambridge, United Kingdom
Ussetti, Piedad:: Hospital Universitario Puerta de Hierro, Madrid, Spain
Sole, Amparo:: Hospital Universitario la Fe, Valencia, Spain
Müller-Quernheim J:: Department of Pneumology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
Voelp, Andreas:: Consultant, Hamburg, Germany
Behr, Juergen:: Department of Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
Neurohr, Claus:: Department of Pulmonology and Respiratory Medicine, Robert-Bosch-Hospital, Stuttgart, Germany