Multi-state modeling of baseline lung allograft dysfunction in lung transplant recipients

Résumé fourni par la source

Background: Baseline lung allograft dysfunction (BLAD) is defined as the failure to achieve normal baseline lung function after lung transplantation (LTX), diagnosed in more than a third of LTX recipients and associated with significant mortality. Previous studies identified BLAD as risk factor for mortality, while evolution, transitions, and risk factors influencing transitions from BLAD to normal lung function or death/re-transplantation remain unknown. Methods: We performed a retrospective study of 472 LTX recipients transplanted between 2010 and 2018, using a Markov multi-state model (MSM) to characterize lung function evolution. The model investigated transitions between “indeterminate”, “BLAD”, “normal baseline lung function” and “death/retransplantation” states. Here we characterize state transitions, association of BLAD with mortality, and risk factors influencing transitions and mortality. Results: This study showed a higher mortality risk for BLAD, particularly in single lung transplant (SLTX) compared to double lung transplant (DLTX) recipients. DLTX recipients with obstructive underlying disease were more likely to recover from BLAD but faced higher mortality if remaining in BLAD. CLAD had a strong association with mortality in patients with normal baseline lung function, but less pronounced in patients in the BLAD state. Our analysis demonstrated that DLTX recipients often recover from BLAD, while SLTX recipients rarely achieve normal lung function if starting in BLAD. Conclusions: Our study delineates for the first time differences in lung function evolution between SLTX and DLTX recipients and risk factors influencing transitions between BLAD and non-BLAD states.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.