Intra-subject variability in oscillometry correlates with acute rejection and CLAD post-lung transplant
BackgroundChronic lung allograft dysfunction (CLAD) is the major cause of death post-lung transplantation, with acute cellular rejection (ACR) being the biggest contributing risk factor. Although patients are routinely monitored with spirometry, FEV1 is stable or improving in most ACR episodes. In c...
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Frontiers Media S.A.
2023-05-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2023.1158870/full |
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| author | Anastasiia Vasileva Nour Hanafi Ella Huszti John Matelski Natalia Belousova Natalia Belousova Joyce K. Y. Wu Joyce K. Y. Wu Tereza Martinu Tereza Martinu Rasheed Ghany Shaf Keshavjee Shaf Keshavjee Jussi Tikkanen Jussi Tikkanen Marcelo Cypel Marcelo Cypel Jonathan C. Yeung Jonathan C. Yeung Clodagh M. Ryan Clodagh M. Ryan Chung-Wai Chow Chung-Wai Chow |
| author_facet | Anastasiia Vasileva Nour Hanafi Ella Huszti John Matelski Natalia Belousova Natalia Belousova Joyce K. Y. Wu Joyce K. Y. Wu Tereza Martinu Tereza Martinu Rasheed Ghany Shaf Keshavjee Shaf Keshavjee Jussi Tikkanen Jussi Tikkanen Marcelo Cypel Marcelo Cypel Jonathan C. Yeung Jonathan C. Yeung Clodagh M. Ryan Clodagh M. Ryan Chung-Wai Chow Chung-Wai Chow |
| author_sort | Anastasiia Vasileva |
| collection | DOAJ |
| description | BackgroundChronic lung allograft dysfunction (CLAD) is the major cause of death post-lung transplantation, with acute cellular rejection (ACR) being the biggest contributing risk factor. Although patients are routinely monitored with spirometry, FEV1 is stable or improving in most ACR episodes. In contrast, oscillometry is highly sensitive to respiratory mechanics and shown to track graft injury associated with ACR and its improvement following treatment. We hypothesize that intra-subject variability in oscillometry measurements correlates with ACR and risk of CLAD.MethodsOf 289 bilateral lung recipients enrolled for oscillometry prior to laboratory-based spirometry between December 2017 and March 2020, 230 had ≥ 3 months and 175 had ≥ 6 months of follow-up. While 37 patients developed CLAD, only 29 had oscillometry at time of CLAD onset and were included for analysis. These 29 CLAD patients were time-matched with 129 CLAD-free recipients. We performed multivariable regression to investigate the associations between variance in spirometry/oscillometry and the A-score, a cumulative index of ACR, as our predictor of primary interest. Conditional logistic regression models were built to investigate associations with CLAD.ResultsMultivariable regression showed that the A-score was positively associated with the variance in oscillometry measurements. Conditional logistic regression models revealed that higher variance in the oscillometry metrics of ventilatory inhomogeneity, X5, AX, and R5-19, was independently associated with increased risk of CLAD (p < 0.05); no association was found for variance in %predicted FEV1.ConclusionOscillometry tracks graft injury and recovery post-transplant. Monitoring with oscillometry could facilitate earlier identification of graft injury, prompting investigation to identify treatable causes and decrease the risk of CLAD. |
| first_indexed | 2024-03-13T09:39:18Z |
| format | Article |
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| language | English |
| last_indexed | 2024-03-13T09:39:18Z |
| publishDate | 2023-05-01 |
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| series | Frontiers in Medicine |
| spelling | doaj.art-2defbe50f0bb477fa163a2215297232e2023-05-25T04:44:44ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2023-05-011010.3389/fmed.2023.11588701158870Intra-subject variability in oscillometry correlates with acute rejection and CLAD post-lung transplantAnastasiia Vasileva0Nour Hanafi1Ella Huszti2John Matelski3Natalia Belousova4Natalia Belousova5Joyce K. Y. Wu6Joyce K. Y. Wu7Tereza Martinu8Tereza Martinu9Rasheed Ghany10Shaf Keshavjee11Shaf Keshavjee12Jussi Tikkanen13Jussi Tikkanen14Marcelo Cypel15Marcelo Cypel16Jonathan C. Yeung17Jonathan C. Yeung18Clodagh M. Ryan19Clodagh M. Ryan20Chung-Wai Chow21Chung-Wai Chow22Division of Respirology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, CanadaDivision of Respirology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, CanadaBiostatistics Research Unit, University Health Network, Toronto, ON, CanadaBiostatistics Research Unit, University Health Network, Toronto, ON, CanadaDivision of Respirology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, CanadaToronto Lung Transplant Program, Ajmera Multi-Organ Transplant Unit, University Health Network, Toronto, ON, CanadaDivision of Respirology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, CanadaPulmonary Function Laboratory, University Health Network, Toronto, ON, CanadaDivision of Respirology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, CanadaToronto Lung Transplant Program, Ajmera Multi-Organ Transplant Unit, University Health Network, Toronto, ON, CanadaToronto Lung Transplant Program, Ajmera Multi-Organ Transplant Unit, University Health Network, Toronto, ON, CanadaToronto Lung Transplant Program, Ajmera Multi-Organ Transplant Unit, University Health Network, Toronto, ON, CanadaDivision of Thoracic Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, CanadaDivision of Respirology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, CanadaToronto Lung Transplant Program, Ajmera Multi-Organ Transplant Unit, University Health Network, Toronto, ON, CanadaToronto Lung Transplant Program, Ajmera Multi-Organ Transplant Unit, University Health Network, Toronto, ON, CanadaDivision of Thoracic Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, CanadaToronto Lung Transplant Program, Ajmera Multi-Organ Transplant Unit, University Health Network, Toronto, ON, CanadaDivision of Thoracic Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, CanadaDivision of Respirology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, CanadaPulmonary Function Laboratory, University Health Network, Toronto, ON, CanadaDivision of Respirology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, CanadaToronto Lung Transplant Program, Ajmera Multi-Organ Transplant Unit, University Health Network, Toronto, ON, CanadaBackgroundChronic lung allograft dysfunction (CLAD) is the major cause of death post-lung transplantation, with acute cellular rejection (ACR) being the biggest contributing risk factor. Although patients are routinely monitored with spirometry, FEV1 is stable or improving in most ACR episodes. In contrast, oscillometry is highly sensitive to respiratory mechanics and shown to track graft injury associated with ACR and its improvement following treatment. We hypothesize that intra-subject variability in oscillometry measurements correlates with ACR and risk of CLAD.MethodsOf 289 bilateral lung recipients enrolled for oscillometry prior to laboratory-based spirometry between December 2017 and March 2020, 230 had ≥ 3 months and 175 had ≥ 6 months of follow-up. While 37 patients developed CLAD, only 29 had oscillometry at time of CLAD onset and were included for analysis. These 29 CLAD patients were time-matched with 129 CLAD-free recipients. We performed multivariable regression to investigate the associations between variance in spirometry/oscillometry and the A-score, a cumulative index of ACR, as our predictor of primary interest. Conditional logistic regression models were built to investigate associations with CLAD.ResultsMultivariable regression showed that the A-score was positively associated with the variance in oscillometry measurements. Conditional logistic regression models revealed that higher variance in the oscillometry metrics of ventilatory inhomogeneity, X5, AX, and R5-19, was independently associated with increased risk of CLAD (p < 0.05); no association was found for variance in %predicted FEV1.ConclusionOscillometry tracks graft injury and recovery post-transplant. Monitoring with oscillometry could facilitate earlier identification of graft injury, prompting investigation to identify treatable causes and decrease the risk of CLAD.https://www.frontiersin.org/articles/10.3389/fmed.2023.1158870/fulloscillometryacute rejection (AR)chronic lung allograft dysfunction (CLAD)lung transplantation (LTx)pulmonary function testing (PFT) |
| spellingShingle | Anastasiia Vasileva Nour Hanafi Ella Huszti John Matelski Natalia Belousova Natalia Belousova Joyce K. Y. Wu Joyce K. Y. Wu Tereza Martinu Tereza Martinu Rasheed Ghany Shaf Keshavjee Shaf Keshavjee Jussi Tikkanen Jussi Tikkanen Marcelo Cypel Marcelo Cypel Jonathan C. Yeung Jonathan C. Yeung Clodagh M. Ryan Clodagh M. Ryan Chung-Wai Chow Chung-Wai Chow Intra-subject variability in oscillometry correlates with acute rejection and CLAD post-lung transplant Frontiers in Medicine oscillometry acute rejection (AR) chronic lung allograft dysfunction (CLAD) lung transplantation (LTx) pulmonary function testing (PFT) |
| title | Intra-subject variability in oscillometry correlates with acute rejection and CLAD post-lung transplant |
| title_full | Intra-subject variability in oscillometry correlates with acute rejection and CLAD post-lung transplant |
| title_fullStr | Intra-subject variability in oscillometry correlates with acute rejection and CLAD post-lung transplant |
| title_full_unstemmed | Intra-subject variability in oscillometry correlates with acute rejection and CLAD post-lung transplant |
| title_short | Intra-subject variability in oscillometry correlates with acute rejection and CLAD post-lung transplant |
| title_sort | intra subject variability in oscillometry correlates with acute rejection and clad post lung transplant |
| topic | oscillometry acute rejection (AR) chronic lung allograft dysfunction (CLAD) lung transplantation (LTx) pulmonary function testing (PFT) |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2023.1158870/full |
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