Work

A three-month physiology score correlates with CLAD after lung transplant

Year: 2026

Type: article

Abstract: Rationale Long-term survival after lung transplant is limited by chronic lung allograft dysfunction (CLAD). Oscillometry is a novel pulmonary function technique that complements spirometry. We hypothesise that oscillometry and spirometry at 3 months post-transplant are associated with CLAD.Methods Double lung transplant recipients (n=280) were enrolled from 2017 to 2020 for oscillometry at the first post-transplant spirometry. We excluded re-transplantation and patients missing 3-month oscillometry-spirometry data. Patients who died within 3 years where a CLAD diagnosis was ascertained were included. We used Mann-Whitney U and Pearson’s χ 2 tests for group comparisons, logistic regression to assess the associations of spirometry and oscillometry with CLAD, and receiver operating characteristic curves to identify the threshold values for CLAD.Results At 3 years post-transplant, 129 were alive and CLAD-free while 75 patients had CLAD. Preoperative and perioperative characteristics were similar except for higher body mass index in the CLAD group. At 3 months, CLAD patients had lower forced expiratory volume in 1 s (%FEV 1) and FEV1/FVC (forced vital capacity), and worst lung mechanics with high R5 (resistance at 5 Hz), low X5 (reactance at 5 Hz) and high AX (area of reactance). %FEV1, FEV1/FVC, R5 and R5−19 (difference in resistance from 5 to 19 Hz), X5, X5 z-score and AX were independently associated with CLAD. A composite metric of %FEV1, FEV1/FVC, R5 z-score, R5−19 and AX provided the strongest association with CLAD.Conclusions The 3-month composite spirometry-oscillometry score post-transplant provides risk stratification of CLAD. Patients at risk can be monitored closely, to enable earlier interventions and minimise progression to CLAD.

Source: BMJ Open Respiratory Research

DOI: 10.1136/bmjresp-2026-004228