Longitudinal Forced Vital Capacity Monitoring as a Prognostic Adjunct after Lung Transplantation

Abstract

Rationale: After lung transplantation, spirometric values are routinely followed to assess graft function. FEV 1 is used to characterize chronic allograft dysfunction, whereas the course of FVC change has been less acknowledged and rarely used.Objectives: To better understand the temporal relationship and prognostic ability of FEV 1 and FVC decline after lung transplantation.Methods: Serial FEV 1 and FVC values were studied among 205 bilateral lung transplant recipients. Different decline patterns were characterized and evaluated for prognostic value via restricted mean modeling of mortality and times to other pertinent events.Measurements and Main Results: Baseline FEV 1 was achieved earlier than baseline FVC (median, 296 vs. 378 d; P , 0.0001). Decline in FEV 1 or FVC from their respective post-transplant baselines occurred in 85 patients (41%). Fifty-nine of 85 (69%) had an isolated FEV 1 decline, with 80% later meeting the FVC decline criterion. This subsequent FVC decline was associated with worsening FEV 1 and lower median survival. Twenty-five of 85 patients (29%) demonstrated concurrent FEV 1 and FVC decline. Patients with concurrent decline had higher 1-and 5-year mortality rates (1-yr, 53% vs. 18%, P , 0.0001; 5-yr, 61% vs. 48%, P = 0.001).These patients were more likely to have rapid-onset of spirometry decline (P = 0.05) and lower FEV 1 % predicted (P = 0.04) at presentation.Conclusions: FVC decline from its post-transplant baseline provides valuable prognostic information. Concurrent FEV 1 and FVC decline identifies patients with fulminant, rapid deterioration and is the strongest clinical predictor of poor survival. Subsequent FVC decline in patients with an initial isolated FEV 1 decline identifies disease progression and portends poor prognosis.

Multiple breath washout in pediatric patients after lung transplantation

“…There are very few studies that have evaluated different lung function parameters for monitoring allograft function after LTx, with the majority having only adult cohorts . A previous longitudinal study in lung transplanted adults revealed that a concurrent FEV 1 and FVC decline from baseline is associated with fulminant rapid deterioration and a poor prognosis . These results indicate that a combination of different lung function parameters may be more predictive of disease course and prognosis than any single parameter.…”

Phenotyping Chronic Lung Allograft Dysfunction Using Body Plethysmography and Computed Tomography

“…Various restrictive CLAD phenotypes of CLAD have been previously defined, relying either on irreversible TLC decline in CLAD course below 90% BL , FVC loss at CLAD onset , or TLC ≤ 90% BL and/or FEV1/FVC normal or increased at any time point after CLAD development . All were shown to negatively impact upon graft survival.…”

“…Again inferior outcomes compared to CLAD patients without FVC loss were observed . The prognostic value of FVC course was recently confirmed by Belloli et al, who identified impaired survival in patients with concurrent forced expiratory volume in 1 s (FEV1) and FVC decline . Although prevalence rates for a restrictive phenotype using these indices vary between 30% and 43.5% , no studies directly comparing both definitions in a single cohort have been performed.…”

Daily Home Spirometry: An Effective Tool for Detecting Progression in Idiopathic Pulmonary Fibrosis

“…Within respiratory medicine, home disease monitoring in the form of peak flow measurement is already a feature of asthma self-management, and in lung transplantation recipients, daily surveillance spirometry is used for the detection of episodes of acute rejection (11). It is not known whether the adoption of a similar approach in IPF might be either feasible or clinically useful.…”