Bronchiolitis obliterans syndrome-free survival after lung transplantation: An International Society for Heart and Lung Transplantation Thoracic Transplant Registry analysis.

Lung transplant (LTx) recipients have low long-term survival and a high incidence of bronchiolitis obliterans syndrome (BOS). However, few long-term, multicenter, and precise estimates of BOS-free survival (a composite outcome of death or BOS) incidence exist. This retrospective cohort study of primary LTx recipients (1994-2011) reported to the International Society of Heart and Lung Transplantation Thoracic Transplant Registry assessed outcomes through 2012. For the composite primary outcome of BOS-free survival, we used Kaplan-Meier survival and Cox proportional hazards regression, censoring for loss to follow-up, end of study, and re-LTx. Although standard Thoracic Transplant Registry analyses censor at the last consecutive annual complete BOS status report, our analyses allowed for partially missing BOS data. Due to BOS reporting standards, 99.1% of the cohort received LTx in North America. During 79,896 person-years of follow-up, single LTx (6,599 of 15,268 [43%]) and bilateral LTx (8,699 of 15,268 [57%]) recipients had a median BOS-free survival of 3.16 years (95% confidence interval [CI], 2.99-3.30 years) and 3.58 years (95% CI, 3.53-3.72 years), respectively. Almost 90% of the single and bilateral LTx recipients developed the composite outcome within 10 years of transplantation. Standard Registry analyses "overestimated" median BOS-free survival by 0.42 years and "underestimated" the median survival after BOS by about a half-year for both single and bilateral LTx (p < 0.05). Most LTx recipients die or develop BOS within 4 years, and very few remain alive and free from BOS at 10 years post-LTx. Less inclusive Thoracic Transplant Registry analytic methods tend to overestimate BOS-free survival. The Registry would benefit from improved international reporting of BOS and other chronic lung allograft dysfunction (CLAD) events.

Kulkarni HS ，Cherikh WS ，Chambers DC ，Garcia VC ，Hachem RR ，Kreisel D ，Puri V ，Kozower BD ，Byers DE ，Witt CA ，Alexander-Brett J ，Aguilar PR ，Tague LK ，Furuya Y ，Patterson GA ，Trulock EP 3rd ，Yusen RD ... -  《-》

Double lung, unlike single lung transplantation might provide a protective effect on mortality and bronchiolitis obliterans syndrome.

Fakhro M ，Broberg E ，Algotsson L ，Hansson L ，Koul B ，Gustafsson R ，Wierup P ，Ingemansson R ，Lindstedt S ... -  《Journal of Cardiothoracic Surgery》

Impact of Forced Expiratory Volume in 1 Second (FEV1) and 6-Minute Walking Distance at 3, 6, and 12 Months and Annually on Survival and Occurrence of Bronchiolitis Obliterans Syndrome (BOS) After Lung Transplantation.

Fakhro M ，Ingemansson R ，Algotsson L ，Lindstedt S ... -  《-》

Impact of Donor Arterial Partial Pressure of Oxygen on Outcomes After Lung Transplantation in Adult Cystic Fibrosis Recipients.

Hayes D Jr ，Kopp BT ，Kirkby SE ，Reynolds SD ，Mansour HM ，Tobias JD ，Tumin D ... -  《-》

Post-transplant baseline FEV1 and the development of bronchiolitis obliterans syndrome: an important confounder?

Burton CM ，Iversen M ，Mortensen J ，Carlsen J ，Andersen CB ，Milman N ，Scheike T ... -  《-》