Bronchiolitis obliterans (BO) following allogeneic haematopoietic stem cell transplantation (HSCT) affects peripheral airways. Detection of BO is presently delayed by the low sensitivity of spirometry.We examined the relationship between peripheral airway function and time since HSCT, and compared it with spirometry and clinical indices in 33 clinically stable allogeneic HSCT recipients. The following measurements were performed: lung function, exhaled nitric oxide, forced oscillatory respiratory system resistance and reactance, acinar (Sacin) and conductive airways ventilation heterogeneity and lung clearance index (LCI) measured by multiple breath nitrogen washout. 22 patients underwent repeat visits from which short-term changes were examined.Median time post HSCT was 12 months. Eight patients were clinically diagnosed as having BO. In multivariate analysis, time since HSCT was predicted by Sacin and forced expiratory volume in 1 s % predicted. 20 patients had abnormal Sacin with normal spirometry, whereas none had airflow obstruction with normal Sacin. Sacin and LCI were the only measures to change significantly between two visits, with both worsening. Change in Sacin was the only parameter to correlate with change in chronic graft-versus-host disease grade.In conclusion, peripheral airways ventilation heterogeneity worsens with time after HSCT. Sacin may be more sensitive than spirometry in detecting BO at an early stage, which needs confirmation in a prospective study.

Chronic obstructive pulmonary disease (COPD) is the primary indication for lung transplantation (LTx), but survival benefit is still under debate. We analysed the survival impact of LTx in COPD with a new approach, using the BODE (body mass index, airway obstruction, dyspnoea, exercise capacity) index.We retrospectively reviewed 54 consecutive lung transplants performed for COPD. The pretransplant BODE score was calculated for each patient and a predicted survival was derived from the survival functions of the original BODE index validation cohort. Predicted and observed posttransplant survival was then compared.In the subgroups with a BODE score o7 and ,7, a majority of patients (66% and 69%, respectively) lived for longer after LTx than predicted by their individual BODE index. The median survival was significantly improved in the entire cohort and in the subgroup with a BODE score o7. 4 yrs after LTx a survival benefit was only apparent in patients with a pre-transplant BODE score of o7.In conclusion, while a majority of COPD patients had an individual survival benefit from LTx regardless of their pre-transplant BODE score, a global survival benefit was seen only in patients with more severe disease. This supports the use of the BODE index as a selection criteria for LTx candidates.

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