Measuring the lung volumes of lung transplant recipients is an effective way of identifying patients who are most at-risk of poor outcomes, according to research published today (13 April, 2017) in the European Respiratory Journal.
The research suggests that measuring lung volumes enables physicians to identify patient populations with phenotypes of chronic lung allograft dysfunction (CLAD), which commonly occurs after transplant and is associated with shortened survival.
An accompanying editorial, written by Professor Alan Glanville, provides context on the mechanisms of CLAD phenotypes, and suggests how physicians might incorporate the knowledge gained from the new ERJ research.
Researchers assessed 396 bilateral lung transplant recipients from April 1990 to December 2013, and identified a total of 94 patients presenting with CLAD before death.
The most common phenotypes found in the cohort included restrictive CLAD (R-CLAD), apparent in 20 patients, which was defined as a loss of total lung capacity, in addition to CLAD with air trapping (AT-CLAD) at onset, present in 21 patients and defined as an increased ratio of residual volume to total lung capacity. A further six of the 94 patients with CLAD fulfilled the criteria for both R- and AT-CLAD, suggesting a combination of CLAD phenotypes.
Both R-CLAD and AT-CLAD were associated with increased mortality as the median survival upon CLAD onset was 2.36 years, compared to a median survival of 4.08±3.73 years before CLAD onset, suggesting that the presence of these particular phenotypes is indicative of earlier mortality.
The authors argue that measuring lung volume to identify patients with phenotypes of CLAD may enable physicians to recognise at-risk patients who may require special considerations.