Longitudinal Forced Vital Capacity Monitoring as a Prognostic Adjunct after Lung Transplantation
Longitudinal Forced Vital Capacity Monitoring as a Prognostic Adjunct after Lung Transplantation
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DOI：
10.1164/rccm.201501-0174oc
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发表时间：
2015-07-15
影响因子：
24.7
通讯作者：
Lama, Vibha N.
中科院分区：
文献类型：
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作者：
Belloli, Elizabeth A.;Wang, Xin;Lama, Vibha N.
基本原理：肺移植后，常规监测肺活量值以评估移植物功能。 FEV1用于表征慢性同种异体移植功能障碍，而FVC变化的过程却鲜为人知且很少使用。 目的：更好地了解肺移植后FEV1和FVC下降的时间关系和预后能力。方法：对205名双侧肺移植受者的连续FEV1和FVC值进行研究。通过死亡率和其他相关事件时间的限制平均模型来表征不同的下降模式并评估其预后价值。测量和主要结果：基线 FEV1 比基线 FVC 更早达到基线 FVC（中位数，296 天与 378 天；P < 0.0001）。 85 名患者 (41%) 的 FEV1 或 FVC 相对于各自的移植后基线有所下降。 85 人中的 59 人 (69%) 出现孤立的 FEV1 下降，其中 80% 后来满足 FVC 下降标准。随后的 FVC 下降与 FEV1 恶化和中位生存率降低相关。 85 名患者中的 25 名 (29%) 表现出 FEV1 和 FVC 同时下降。同时发生衰退的患者具有较高的 1 年和 5 年死亡率（1 年，53% vs. 18%，P < 0.0001；5 年，61% vs. 48%，P = 0.001）。这些患者就诊时更有可能出现肺活量快速下降 (P = 0.05) 和预测的 FEV1% 较低 (P = 0.04)。结论：FVC 从移植后基线下降可提供有价值的预后信息。 FEV1 和 FVC 的同时下降表明患者患有暴发性、快速恶化，并且是生存不良的最强临床预测因子。最初出现孤立的 FEV1 下降的患者随后出现 FVC 下降可确定疾病进展并预示预后不良。
Rationale: After lung transplantation, spirometric values are routinely followed to assess graft function. FEV1 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 FEV1 and FVC decline after lung transplantation.Methods: Serial FEV1 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 FEV1 was achieved earlier than baseline FVC (median, 296 vs. 378 d; P < 0.0001). Decline in FEV1 or FVC from their respective post-transplant baselines occurred in 85 patients (41%). Fifty-nine of 85 (69%) had an isolated FEV1 decline, with 80% later meeting the FVC decline criterion. This subsequent FVC decline was associated with worsening FEV1 and lower median survival. Twenty-five of 85 patients (29%) demonstrated concurrent FEV1 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 FEV1% predicted (P = 0.04) at presentation.Conclusions: FVC decline from its post-transplant baseline provides valuable prognostic information. Concurrent FEV1 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 FEV1 decline identifies disease progression and portends poor prognosis.