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Development of a multivariate prediction model for early-onset bronchiolitis obliterans syndrome and restrictive allograft syndrome in lung transplantation

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Koutsokera, Angela | Royer, Pierre J. | Antonietti, Jean P. | Fritz, Andreas | Benden, Christian | Aubert, John D. | Tissot, Adrien | Botturi, Karine | Roux, Antoine | Reynaud-Gaubert, Martine L. | Kessler, Romain | Dromer, Claire | Mussot, Sacha | Mal, Herve | Mornex, Jean-Francois | Guillemain, Romain | Knoop, Christiane | Dahan, Marcel | Soccal, Paola M. | Claustre, Johanna | Sage, Edouard | Gomez, Carine | Magnan, Antoine | Pison, Christophe | Nicod, Laurent P. | Chung, Kian, Fan | Wewers, Mark | Hillerdal, Gunnar, N

Edité par CCSD ; Frontiers media -

International audience. Background: Chronic lung allograft dysfunction and its main phenotypes, bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS), are major causes of mortality after lung transplantation (LT). RAS and early-onset BOS, developing within 3 years after LT, are associated with particularly inferior clinical outcomes. Prediction models for early-onset BOS and RAS have not been previously described. Methods: LT recipients of the French and Swiss transplant cohorts were eligible for inclusion in the SysCLAD cohort if they were alive with at least 2 years of follow-up but less than 3 years, or if they died or were retransplanted at any time less than 3 years. These patients were assessed for early-onset BOS, RAS, or stable allograft function by an adjudication committee. Baseline characteristics, data on surgery, immunosuppression, and year-1 follow-up were collected. Prediction models for BOS and RAS were developed using multivariate logistic regression and multivariate multinomial analysis. Results: Among patients fulfilling the eligibility criteria, we identified 149 stable, 51 BOS, and 30 RAS subjects. The best prediction model for early-onset BOS and RAS included the underlying diagnosis, induction treatment, immunosuppression, and year-1 class II donor-specific antibodies (DSAs). Within this model, class II DSAs were associated with BOS and RAS, whereas pre-LT diagnoses of interstitial lung disease and chronic obstructive pulmonary disease were associated with RAS. Conclusion: Although these findings need further validation, results indicate that specific baseline and year-1 parameters may serve as predictors of BOS or RAS by 3 years post-LT. Their identification may allow intervention or guide risk stratification, aiming for an individualized patient management approach.

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