Air Pollution and the Development of Posttransplant Chronic Lung Allograft Dysfunction

Abstract

Chronic lung allograft dysfunction (CLAD) is the leading cause of mortality following lung transplantation. We conducted a retrospective cohort study including 397 bilateral lung recipients transplanted in from 1996 to 2009 to determine the association between ambient air pollution, CLAD and mortality. Pollution exposure was assessed using satellite‐based estimates of nitrogen dioxide, distance to major roadway and total length of roadways around a patient's home. Cumulative exposures to ozone and particulate matter were estimated from concentrations measured at fixed‐site stations near patients' homes using inverse distance weighted interpolation. Cox proportional hazards models were used to estimate the associations of CLAD with air pollution exposure, adjusting for various individual and neighborhood characteristics. During the follow‐up, 185 patients developed CLAD (47%) and 101 patients died (25%). Fifty‐four deaths (53%) were due to CLAD. We observed an association between CLAD development and road density within 200 m of a patient's home (HR 1.30 [95% CI 1.07–1.58]). Although based on a subgroup of 14 patients, living within 100 m of a highway was associated with a high risk for developing CLAD (HR 4.91 [95% CI 2.22, 10.87]). These data suggest that exposure to traffic‐related air pollution is associated with development of CLAD among lung transplant recipients.

Air pollution and subclinical interstitial lung disease: the Multi-Ethnic Study of Atherosclerosis (MESA) air–lung study

“…Many studies have shown associations between pollution exposure and the incidence and/or progression of multiple pulmonary diseases, including asthma, 1 COPD, 2 bronchiectasis, 3 respiratory infections, 4 chronic lung allograft dysfunction 5 and lung cancer. 6 There has been little research on whether air pollution may contribute to the etiology or accelerate the progression of interstitial lung diseases (ILDs), a heterogeneous group of chronic lung diseases characterized by inflammation and fibrosis of the pulmonary parenchyma that affect nearly 1 out of 200 older adults in the U.S. 7 …”

Environmental Exposures—The Missing Link in Immune Responses After Transplantation

“…For each 10‐fold increase in distance from major roads, hazard ratios and mortality went down for these patients . These findings have since been replicated .…”

Chronic effects of air pollution on lung function after lung transplantation in the Systems prediction of Chronic Lung Allograft Dysfunction (SysCLAD) study

“…Few studies have estimated the impact of chronic exposure to ambient air pollutants in lung transplant recipients (LTRs), a population with a potential higher sensitivity to air pollution exposure due to cumulative effects of ischaemic reperfusion insult and innate and adaptive immune activation. Two previous studies have indicated that traffic-related air pollution, assessed with proximity to major road, was associated with the risk of development of CLAD, bronchiolitis obliterans syndromes (BOS) and of mortality after lung transplantation [14,15]. The Canadian study did not detect any significant association between CLAD occurrence and mean annual concentrations of particulate matter with an aerodynamic cut-off of 2.5 µm (PM2.5), ozone (O 3 ) and nitrogen dioxide (NO 2 ) estimated at the residential address using nearby fixed-site monitoring stations [14].…”