Baseline Lung Allograft Dysfunction after Lung Transplantation is Not Associated with Donor Factors

Abstract

Purpose After lung transplantation (LTx), lung function usually increases over the first 12 months. The peak forced expiratory volume (FEV1) reached within this first year serves as the baseline value for the further clinical course and for CLAD diagnosis. However, in a number of patients FEV1 fails to increase to adequate levels and remains below 65% of the predicted value, a condition termed baseline lung allograft dysfunction (BLAD). Risk factors of BLAD and how it impacts survival and CLAD diagnosis are still poorly understood. Methods We analyzed patients receiving primary double LTx between January 2010 and December 2018 at our center. Lobar LTx, pediatric patients and patients lost within the first 12 months were excluded. Post-transplant lung function trajectories were analyzed. Patients who failed to reach normal lung function (defined as FEV1>65% of the predicted value) formed a BLAD group. A control group consisted of patients who achieved adequate FEV1-values. Demographics and outcome factors including length of mechanical ventilation, PGD and graft survival were compared. A binary logistic regression analysis of donor parameters was performed to determine risk factors of BLAD. Results Of 598 patients included in the study, 77 (12.9%) did not reach an adequate lung function. Patients in group I reached their best FEV1 sooner (median 61 days; IQR: 15-282) compared to the control group (median 296 days; IQR: 113-613) (p 20pyrs and organ ischemic time) reached statistical significance. Conclusion Although BLAD may complicate the diagnosis of CLAD, it was not associated with impaired long-term outcomes. Donor quality was not associated with BLAD but affected patients had a complicated perioperative course more often than control patients.