Continuous Distribution of Lungs Decreases Waiting List Mortality without Compromising 6-Month Post-Transplant Outcomes
Year: 2025
Type: article
Study design: Observational Study
Abstract: Purpose:The forced expiratory volume in one second (FEV1) is the standard measure for monitoring lung allograft function.However, little is known about FEV1 trajectories and their associations with clinical outcomes.Methods: Adult patients who received a bilateral lung transplantation were included from 15 centers in France, Belgium, Austria and the US, between 2010 and 2021.All centers performed routine spirometry measurements post lung transplantation at regular intervals.All centers performed routine spirometry measurements commencing shortly after lung transplantation and continuing at regular intervals of maximum three months afterwards.Recipient, donor and transplant characteristics were collected for each patient.Latent class mixed models were used to identify FEV1 trajectories.Results: A total of 2,305 patients were included with 59,034 FEV1 measurements performed.The median follow-up post-transplantation was 6.5 years (IQR 4.0-9.0).In the development cohort, the best latent class mixed model identified seven clinically meaningful FEV1 trajectories (Figure).Trajectory #1 (24.7%) was characterized by patients with moderate and stable lung function (5-years patient survival = 79.1%);trajectory #2 (23.4%) and #3 (28.3%) were characterized by patients with moderate/high and stable lung function (5-years patient survival = 94.2% and 90.7% respectively) ; trajectory #4 (3.6%) was characterized by patients with increasing lung function (5-years patient survival = 72.7%); trajectory #5 (3.6%) was characterized by patients with a slow decline (5-years patient survival = 68.9%); and trajectory #6 (3.1%) and #7 (4.3%) were characterized by patients with accelerated decline (5-years patient survival = 21.1% and 42.3 % respectively).Similar FEV1 trajectories and patient outcomes were identified in the external validation cohorts on the basis of independent analyses.The trajectories were also confirmed in a series of subpopulations.Last, FEV 1 value and slope assessed at 1 year post transplant were strongly associated with FEV 1 trajectories.Conclusions: We identified FEV1 trajectories that capture different clinical scenarios associated with lung recipients outcomes.Our results provide the basis for a trajectory-based assessment of lung transplant patients.
Authors: C. Hawkins, S. Weiss, J. Foutz, M. Budev, D. Lyu, M. Hartwig
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,300
OpenAlex ID: W4412851260