Combined diffusing capacity for nitric oxide and carbon monoxide as predictor of bronchiolitis obliterans syndrome following lung transplantation

Winkler, Anna; Kahnert, Kathrin; Behr, Jürgen; Neurohr, Claus; Kneidinger, Nikolaus; Hatz, Rudolf; Dressel, Holger; Radtke, Thomas; Jörres, Rudolf A.

doi:10.1186/s12931-018-0881-1

Cited by 3 publications

(1 citation statement)

References 39 publications

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“…We argue that D LCOcor decline and spirometric decline appear to be related metrics of CLAD. In a cross-sectional study, the diffusion capacity for nitrous oxide allowed for early detection of BOS, and this requires further longitudinal prospective evaluation [29]. Any D LCOcor decline was independently associated with reduced survival.…”

Section: Discussionmentioning

confidence: 99%

Diffusing capacity of the lung for carbon monoxide: association with long-term outcomes after lung transplantation in a 20-year longitudinal study

Darley

Huszti

et al. 2021

Eur Respir J

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RationaleThe diffusing capacity for carbon monoxide corrected for haemoglobin (DLCOcor), measures gas movement across the alveolar-capillary interface. We hypothesised that DLCOcor is a sensitive measure of injurious allograft processes disrupting this interface.ObjectivesTo determine the prognostic significance of the DLCOcor trajectory on chronic lung allograft dysfunction (CLAD) and survival.MethodsA retrospective analysis was conducted of all bilateral lung transplant recipients at a single centre, between Jan-1998 and Jan-2018, with ≥1 DLCOcor measurements. Low baseline DLCOcor was defined as the failure to achieve a DLCOcor >75% predicted. Drops in DLCOcor were defined as >15% below recent baseline.Results1259/1492 lung transplant recipients were included. The median time to peak DLCOcor was 354 (range 181–737) days and the mean %-predicted DLCOcor was 80.2% (sd 21.2). Multivariable analysis demonstrated that low baseline DLCOcor was significantly associated with death (HR 1.68, 95% CI 1.27–2.20, p<0.001). Low baseline DLCOcor was not independently associated with CLAD after adjustment for low baseline FEV1 or FVC. Any DLCOcor declines ≥15% were significantly associated with death, independent of concurrent spirometric decline. Lower %-predicted DLCOcor values at CLAD onset were associated with shorter post-CLAD survival (HR 0.75 per 10%-unit change, p<0.01).ConclusionLow baseline DLCOcor and post-transplant declines in DLCOcor were significantly associated with survival, independent of spirometric measurements. We propose that DLCOcor testing may allow identification of a sub-phenotype of baseline and chronic allograft dysfunction not captured by spirometry. There may be benefit in routine monitoring of DLCOcor after lung transplantation to identify patients at risk of poor outcomes.

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Section: Discussionmentioning

confidence: 99%