Significance of best spirometry in the first year after bilateral lung transplantation: Association with 3-year outcomes

Manish R. Mohanka, Rohan Kanade, Heriberto Garcia, Luke Mahan, Srinivas Bollineni, Jessica Mullins, John Joerns, Vaidehi Kaza, Fernando Torres, Song Zhang, Amit Banga

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background. Spirometry is the cornerstone of monitoring allograft function after lung transplantation (LT). We sought to determine the association of variables on best spirometry during the first year after bilateral LT with 3-year posttransplant survival. Methods. We reviewed charts of patients who survived at least 3 months after bilateral LT (n = 157; age ± SD: 54 ± 13 y, male:female = 91:66). Best spirometry was calculated as the average of 2 highest measurements at least 3 weeks apart during the first year. Airway obstruction was defined as forced expiratory volume in 1-second (FEV1)/forced vital capacity (FVC) ratio <0.7. Survival was compared based on the ventilatory defect and among groups based on the best FEV1and FVC measurements (>80%, 60%-80%, and <60% predicted). Primary outcome was 3-year survival. Results. Overall, 3-year survival was 67% (n = 106). Obstructive defect was uncommon (7%) and did not have an association with 3-year survival (72% versus 67%, P = 0.7). Although one-half patients achieved an FVC>80% predicted (49%), 1 in 5 (19%) remained below 60% predicted. Irrespective of the type of ventilatory defect, survival worsened as the best FVC (% predicted) got lower (>80: 80.8%; 60-80: 63.3%; <60: 40%; P < 0.001). On multivariate logistic regression analysis, after adjusting for age, gender, transplant indication, and annual bronchoscopy findings, best FVC (% predicted) during the first year after LT was independently associated with 3-year survival. Conclusions. A significant proportion of bilateral LT patients do not achieve FVC>80% predicted. Although the type of ventilatory defect on best spirometry does not predict survival, failure to achieve FVC>80% predicted during the first year was independently associated with 3-year mortality.

Original languageEnglish (US)
Pages (from-to)1712-1719
Number of pages8
JournalTransplantation
Volume104
Issue number8
DOIs
StatePublished - Aug 1 2020

ASJC Scopus subject areas

  • Transplantation

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