Air Pollution and the Development of Posttransplant Chronic Lung Allograft Dysfunction
Air Pollution and the Development of Posttransplant Chronic Lung Allograft Dysfunction
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DOI：
10.1111/ajt.12909
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发表时间：
2014-12-01
影响因子：
8.8
通讯作者：
Singer, L. G.
中科院分区：
文献类型：
--
作者：
Bhinder, S.;Chen, H.;Singer, L. G.
慢性肺移植物功能障碍（CLAD）是肺移植后死亡的主要原因。我们进行了一项回顾性队列研究，包括1996年至2009年的397例双侧肺移植受者，以确定环境空气污染，CLAD和死亡率之间的关系。污染暴露评估使用基于卫星的估计二氧化氮，距离主要道路和总长度的道路周围的病人的家。臭氧和颗粒物的累积暴露量是通过使用反距离加权插值法在患者家附近的固定站点测量的浓度来估计的。考克斯比例风险模型被用来估计CLAD与空气污染暴露的关联，调整各种个人和邻居的特点。在随访期间，185例患者发生CLAD（47%），101例患者死亡（25%）。54例死亡（53%）是由于CLAD。我们观察到CLAD发展与患者家200米范围内的道路密度之间存在相关性（HR 1.30 [95%CI 1.07-1.58]）。尽管基于14例患者的亚组，但居住在高速公路100 m范围内与发生CLAD的高风险相关（HR 4.91 [95% CI 2.22，10.87]）。这些数据表明，暴露于交通相关的空气污染与肺移植recipients.This回顾性队列研究CLAD的发展表明，在受体的家庭住址交通相关的空气污染的替代措施和慢性肺移植功能障碍的发展之间的关联。
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 200m of a patient's home (HR 1.30 [95% CI 1.07-1.58]). Although based on a subgroup of 14 patients, living within 100m 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.This retrospective cohort study demonstrates an association between surrogate measures of traffic-related air pollution at recipients' home addresses and the development of chronic lung allograft dysfunction.