This Article Full Text Full Text (PDF) All Versions of this Article: 200501-097OCv1 172/3/379    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lama, V. N. Articles by Martinez, F. J. Search for Related Content PubMed PubMed Citation Articles by Lama, V. N. Articles by Martinez, F. J.

Prognostic Value of Bronchiolitis Obliterans Syndrome Stage 0-p in Single-Lung Transplant Recipients

Division of Pulmonary and Critical Care Medicine, Department of Biostatistics, University of Michigan School of Public Health; and the Section of Thoracic Surgery, University of Michigan Health System, Ann Arbor, Michigan

Correspondence and requests for reprints should be addressed to Vibha N. Lama, M.D., M.S., Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, 1500 East Medical Center Drive, 3916 Taubman Center, Ann Arbor, MI 48109-0360. E-mail: vlama{at}umich.edu

Rationale: Early diagnosis of bronchiolitis obliterans syndrome (BOS) is critical in understanding pathogenesis and devising therapeutic trials. Although potential-BOS stage (BOS 0-p), encompassing early changes in FEV₁ and forced expiratory flow, midexpiratory phase (FEF_25–75%), has been proposed, there is a paucity of data validating its utility in single-lung transplantation. Objective: The aim of this study was to define the predictive ability of BOS 0-p in single-lung transplantation. Methods: We retrospectively analyzed spirometric data for 197 single-lung recipients. Sensitivity, specificity, and positive predictive value of BOS 0-p were examined over time using Kaplan-Meier methodology. Results: BOS 0-p FEV₁ was associated with higher sensitivity, specificity, and positive predictive value than the FEF_25–75% criterion over different time periods investigated. The probability of testing positive for BOS 0-p FEV₁ in patients with BOS (sensitivity) was 71% at 2 years before the onset of BOS. The probability of being free from development of BOS 0-p FEV₁ in patients free of BOS at follow-up (specificity) was 93% within the last year. Of patients who met the BOS 0-p FEV₁ criterion, 81% developed BOS or died within 3 years. The specificity and positive predictive value curves for the BOS 0-p FEV₁ were significantly different between patients with underlying restrictive versus obstructive physiology (p = 0.05 and 0.01, respectively). Conclusion: The FEV₁ criterion for BOS 0-p provides useful predictive information regarding the risk of development of BOS or death in single-lung recipients. The predictive value of this criterion is higher in patients with underlying restriction and is superior to the FEF_25–75% criterion.

Key Words: bronchiolitis obliterans syndrome • diagnosis • lung transplantation • staging

This article has been cited by other articles:

				J.-F. Cordier Challenges in pulmonary fibrosis {middle dot} 2 : Bronchiolocentric fibrosis Thorax, July 1, 2007; 62(7): 638 - 649. [Abstract] [Full Text] [PDF]

				V. N. Lama, S. Murray, R. J. Lonigro, G. B. Toews, A. Chang, C. Lau, A. Flint, K. M. Chan, and F. J. Martinez Course of FEV1 after Onset of Bronchiolitis Obliterans Syndrome in Lung Transplant Recipients Am. J. Respir. Crit. Care Med., June 1, 2007; 175(11): 1192 - 1198. [Abstract] [Full Text] [PDF]

				M. Estenne and R. M. Kotloff Update in transplantation 2005. Am. J. Respir. Crit. Care Med., March 15, 2006; 173(6): 593 - 598. [Full Text] [PDF]

				A. Van Muylem, P. Scillia, C. Knoop, M. Paiva, and M. Estenne Single-breath test in lateral decubitus reflects function of single lungs grafted for emphysema J Appl Physiol, March 1, 2006; 100(3): 834 - 838. [Abstract] [Full Text] [PDF]