TY - JOUR
T1 - Acute cellular rejection is a risk factor for bronchiolitis obliterans syndrome independent of post-transplant baseline FEV1
AU - Burton, Christopher M
AU - Iversen, Martin
AU - Carlsen, Jørn
AU - Mortensen, Jann
AU - Andersen, Claus B
AU - Steinbrüchel, Daniel
AU - Scheike, Thomas
PY - 2009/9
Y1 - 2009/9
N2 - BACKGROUND: Post-transplant baseline forced expiratory volume in 1 second (FEV(1)) constitutes a systematic bias in analyses of bronchiolitis obliterans syndrome (BOS). This retrospective study evaluates risk factors for BOS adjusting for the confounding of post-transplant baseline FEV(1).METHODS: A multivariate survival and competing risk analysis of a large consecutive series of patients (n = 389) from a national center 1992 to 2004. Exclusion criteria were patients not surviving at least 3 months after transplantation (n = 39) and no available lung function measurements (n = 4).RESULTS: The first maximum FEV(1) occurred at a median 183 days post-transplant. Freedom from BOS was 81%, 53%, 38% and 15%, and cumulative incidence of BOS was 18%, 43%, 57% and 77% at 1, 3, 5 and 10 years post-transplantation, respectively. Acute cellular rejection was independently associated with an increased cause-specific hazard of BOS (hazard ratio 1.4, confidence interval 1.1 to 1.8, p = 0.009). The absolute value of baseline FEV(1) was a significant confounder in all survival and competing risk analyses of BOS (p < 0.05).CONCLUSION: Despite early diagnosis and prompt treatment, acute cellular rejection remains an independent risk factor for the development of BOS after adjusting for the confounding of post-transplant baseline FEV(1).
AB - BACKGROUND: Post-transplant baseline forced expiratory volume in 1 second (FEV(1)) constitutes a systematic bias in analyses of bronchiolitis obliterans syndrome (BOS). This retrospective study evaluates risk factors for BOS adjusting for the confounding of post-transplant baseline FEV(1).METHODS: A multivariate survival and competing risk analysis of a large consecutive series of patients (n = 389) from a national center 1992 to 2004. Exclusion criteria were patients not surviving at least 3 months after transplantation (n = 39) and no available lung function measurements (n = 4).RESULTS: The first maximum FEV(1) occurred at a median 183 days post-transplant. Freedom from BOS was 81%, 53%, 38% and 15%, and cumulative incidence of BOS was 18%, 43%, 57% and 77% at 1, 3, 5 and 10 years post-transplantation, respectively. Acute cellular rejection was independently associated with an increased cause-specific hazard of BOS (hazard ratio 1.4, confidence interval 1.1 to 1.8, p = 0.009). The absolute value of baseline FEV(1) was a significant confounder in all survival and competing risk analyses of BOS (p < 0.05).CONCLUSION: Despite early diagnosis and prompt treatment, acute cellular rejection remains an independent risk factor for the development of BOS after adjusting for the confounding of post-transplant baseline FEV(1).
KW - Adult
KW - Bronchiolitis Obliterans/epidemiology
KW - Death
KW - Female
KW - Forced Expiratory Volume
KW - Graft Rejection/complications
KW - Heart-Lung Transplantation/adverse effects
KW - Humans
KW - Incidence
KW - Lung Diseases/classification
KW - Lung Transplantation/adverse effects
KW - Male
KW - Middle Aged
KW - Retrospective Studies
KW - Risk Factors
KW - Survival Analysis
KW - Survivors
KW - Time Factors
U2 - 10.1016/j.healun.2009.04.022
DO - 10.1016/j.healun.2009.04.022
M3 - Journal article
C2 - 19716040
SN - 1053-2498
VL - 28
SP - 888
EP - 893
JO - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
JF - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
IS - 9
ER -