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Publications

Journal Article Epublish

PubMed: 42256236 DOI: 10.1016/j.jhlto.2026.100575

Early detection of chronic lung allograft dysfunction with spectral and intrabreath oscillometry.

JHLT Open 13:100575

Authors: Anne Fu, Anastasiia Vasileva, Nour Hanafi, Natalia Belousova, Joyce K Y Wu, Ella Huszti, Zoltán Hantos, Chung-Wai Chow

Affiliations

  • Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
  • Thoracic Medicine and Lung Transplant Unit, St Vincent's Hospital, Sydney, Australia.
  • Pulmonary Function Laboratory, University Health Network, Toronto, Ontario, Canada.
  • Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada.
  • Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary.
  • Toronto Lung Transplant Program, Ajmera Multi-Organ Transplant Unit, University Health Network, Toronto, Ontario, Canada.

Abstract

BACKGROUND

Chronic lung allograft dysfunction (CLAD) is the main obstacle to long-term survival after lung transplantation. CLAD is defined by a sustained >3-month drop in the forced expiratory volume in 1 sec (FEV 1) to ≤80% of the baseline value when other causes are ruled out. Oscillometry is a pulmonary function modality that is sensitive to lung mechanics. This study investigated whether oscillometry at the initial ≥20% drop in FEV 1 is associated with CLAD.

METHODS

This cross-sectional study analyzed 384 double lung recipients transplanted between December 2017 and January 2023. Patients who recovered within 3 months after the initial FEV 1 drop ≥20% ( reversible dropFEV 1, n = 25) and those who developed CLAD (n = 49) were matched by duration post-transplant to patients who had not experienced FEV 1 drop ( stableFEV 1, n = 310). We used Wilcoxon tests with Bonferroni correction for pairwise group comparisons, and logistic regression to analyze the strength of associations between oscillometry and CLAD.

FINDINGS

At initial ≥20% FEV 1 drop, stableFEV 1 patients exhibited significantly better spirometry and oscillometry than CLAD and reversible dropFEV 1 patients. While spirometry could not distinguish between reversible dropFEV 1 and CLAD, oscillometry could. Reactance at 5 Hz (X5) was significantly (p<0.05) worse in the CLAD than reversible dropFEV 1 patients and patients with lower X5 had an increased risk of CLAD (OR = 1.90 [1.01-3.57]).

CONCLUSIONS

X5 differentiated between patients who developed CLAD from those whose FEV 1 recovered. Lower X5 (i.e., greater lung stiffness) at time of FEV 1 drop identifies patients who are more likely to develop CLAD.

MeSH

Lung, Spirometry, Transplants, Allografts