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

Michael, Gerckens; Alexander, Richard; Paola, Arnold; Tobias, Veit; Jürgen, Barton; Jeremias, Götschke; Katrin, Milger; Teresa, Kauke; Christian, Schneider; Sebastian, Michel; Michael, Irlbeck; Malte, Luecken; Ali Önder, Yildirim; Nikolaus, Kneidinger; Carlo, Mümmler (2025): Multi-state modeling of baseline lung allograft dysfunction in lung transplant recipients. ERJ Open Research. ISSN 2312-0541

Abstract

Background:Baseline lung allograft dysfunction (BLAD) is characterized by the failure to achieve normal baseline lung function after lung transplantation (LTX), affecting over a third of LTX recipients and conveying significant mortality. While previous studies identified BLAD as risk factor for mortality, evolution, transitions, and risk factors influencing transitions from BLAD to normal lung function or death/retransplantation remain unknown.

Methods: We conducted a retrospective study of 472 LTX recipients transplanted between 2010-2018, 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. We modeled state transitions, association of BLAD with mortality, and risk factors influencing transitions and mortality through respective states.

Results: Our study confirms a higher mortality risk for BLAD, particularly in SLTX compared to DLTX recipients. DLTX recipients with obstructive underlying disease were more likely to recover from BLAD (HR 3.1) but faced higher mortality if remaining in BLAD (HR 2.6). CLAD had a strong association with mortality in patients with normal baseline lung function (HR 5.1) but also to a lesser extent in BLAD patients (HR 1.8). Longitudinal analysis demonstrated that DLTX recipients often recover from BLAD, while SLTX recipients rarely achieve normal lung function if starting in BLAD.

Conclusions: Our study highlights differences in lung function evolution between SLTX and DLTX recipients and investigates for the first time prevalence and risk factors for transitions between BLAD and non-BLAD states, as well as risk factors influencing BLAD-related mortality in LTX recipients.

• Dokumententyp: Artikel (Klinikum der LMU)
• Organisationseinheit (Fakultäten): 07 Medizin > Klinikum der LMU München > Medizinische Klinik und Poliklinik V (Pneumologie)
• DFG-Fachsystematik der Wissenschaftsbereiche: Lebenswissenschaften