Supranormal expiratory airflow after bilateral lung transplantation is associated with improved survival

Michael Eberlein, Solbert Permutt, Robert Howard Brown, Allison Brooker, Mayy F. Chahla, Servet Bolukbas, Steven D. Nathan, David B Pearse, Jonathan B Orens, Roy G Brower

Research output: Contribution to journalArticle

Abstract

Rationale: Flow volume loops (FVL) in some bilateral lung transplant (BLT) and heart-lung transplant (HLT) patients suggest variable extrathoracic obstruction in the absence of identifiable causes. These FVLs usually have supranormal expiratory and normal inspiratory flow rates (SUPRA pattern). Objectives: Characterize the relationship of the SUPRA pattern to predicted donor and recipient lung volumes, airway size, and survival. Methods: We performed a retrospective review of adult BLT/HLT patients. We defined the SUPRA FVL pattern as: (1) mid-vital capacity expiratory to inspiratory flow ratio (Ve50:Vi50) > 1.0, (2) absence of identifiable causes of extrathoracic obstruction, and (3) Ve50/FVC≥1.5 s 21. We calculated predicted total lung capacity (pTLC) ratio by dividing the donor pTLC by the recipient pTLC. We measured airway luminal areas on thoracic computer tomographic scans. We compared survival in patients with and without the SUPRA pattern. Measurements and Main Results: The SUPRA FVL pattern occurred in 56% of the 89 patients who qualified for the analysis. The pTLC ratio of SUPRA and non-SUPRA patients was 1.11 and 0.99, respectively (P = 0.004). A higher pTLC ratio was correlated with increased probability of the SUPRA pattern (P = 0.0072). Airway luminal areas were larger in SUPRA patients (P = 0.009). Survival was better in the SUPRA cohort (P = 0.009). Conclusions: The SUPRA FVL pattern was frequent in BLT/HLT patients. High expiratory flows in SUPRA patients could result from increased lungelastic recoilor reduced airway resistance, both of which could be caused by the pTLC mismatch. Improved survival in the SUPRA cohort suggests potential therapeutic approaches to improve outcomes in BLT/HLT patients.

Original languageEnglish (US)
Pages (from-to)79-87
Number of pages9
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume183
Issue number1
DOIs
StatePublished - Jan 1 2011

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Pulmonary Ventilation
Lung Transplantation
Total Lung Capacity
Lung
Transplants
Survival
Tissue Donors
Airway Resistance
Vital Capacity
Thorax

Keywords

  • Dysanapsis
  • Flow volume loops
  • Lung size mismatch
  • Lung transplantation
  • Surface tension

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Supranormal expiratory airflow after bilateral lung transplantation is associated with improved survival. / Eberlein, Michael; Permutt, Solbert; Brown, Robert Howard; Brooker, Allison; Chahla, Mayy F.; Bolukbas, Servet; Nathan, Steven D.; Pearse, David B; Orens, Jonathan B; Brower, Roy G.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 183, No. 1, 01.01.2011, p. 79-87.

Research output: Contribution to journalArticle

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abstract = "Rationale: Flow volume loops (FVL) in some bilateral lung transplant (BLT) and heart-lung transplant (HLT) patients suggest variable extrathoracic obstruction in the absence of identifiable causes. These FVLs usually have supranormal expiratory and normal inspiratory flow rates (SUPRA pattern). Objectives: Characterize the relationship of the SUPRA pattern to predicted donor and recipient lung volumes, airway size, and survival. Methods: We performed a retrospective review of adult BLT/HLT patients. We defined the SUPRA FVL pattern as: (1) mid-vital capacity expiratory to inspiratory flow ratio (Ve50:Vi50) > 1.0, (2) absence of identifiable causes of extrathoracic obstruction, and (3) Ve50/FVC≥1.5 s 21. We calculated predicted total lung capacity (pTLC) ratio by dividing the donor pTLC by the recipient pTLC. We measured airway luminal areas on thoracic computer tomographic scans. We compared survival in patients with and without the SUPRA pattern. Measurements and Main Results: The SUPRA FVL pattern occurred in 56{\%} of the 89 patients who qualified for the analysis. The pTLC ratio of SUPRA and non-SUPRA patients was 1.11 and 0.99, respectively (P = 0.004). A higher pTLC ratio was correlated with increased probability of the SUPRA pattern (P = 0.0072). Airway luminal areas were larger in SUPRA patients (P = 0.009). Survival was better in the SUPRA cohort (P = 0.009). Conclusions: The SUPRA FVL pattern was frequent in BLT/HLT patients. High expiratory flows in SUPRA patients could result from increased lungelastic recoilor reduced airway resistance, both of which could be caused by the pTLC mismatch. Improved survival in the SUPRA cohort suggests potential therapeutic approaches to improve outcomes in BLT/HLT patients.",
keywords = "Dysanapsis, Flow volume loops, Lung size mismatch, Lung transplantation, Surface tension",
author = "Michael Eberlein and Solbert Permutt and Brown, {Robert Howard} and Allison Brooker and Chahla, {Mayy F.} and Servet Bolukbas and Nathan, {Steven D.} and Pearse, {David B} and Orens, {Jonathan B} and Brower, {Roy G}",
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T1 - Supranormal expiratory airflow after bilateral lung transplantation is associated with improved survival

AU - Eberlein, Michael

AU - Permutt, Solbert

AU - Brown, Robert Howard

AU - Brooker, Allison

AU - Chahla, Mayy F.

AU - Bolukbas, Servet

AU - Nathan, Steven D.

AU - Pearse, David B

AU - Orens, Jonathan B

AU - Brower, Roy G

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N2 - Rationale: Flow volume loops (FVL) in some bilateral lung transplant (BLT) and heart-lung transplant (HLT) patients suggest variable extrathoracic obstruction in the absence of identifiable causes. These FVLs usually have supranormal expiratory and normal inspiratory flow rates (SUPRA pattern). Objectives: Characterize the relationship of the SUPRA pattern to predicted donor and recipient lung volumes, airway size, and survival. Methods: We performed a retrospective review of adult BLT/HLT patients. We defined the SUPRA FVL pattern as: (1) mid-vital capacity expiratory to inspiratory flow ratio (Ve50:Vi50) > 1.0, (2) absence of identifiable causes of extrathoracic obstruction, and (3) Ve50/FVC≥1.5 s 21. We calculated predicted total lung capacity (pTLC) ratio by dividing the donor pTLC by the recipient pTLC. We measured airway luminal areas on thoracic computer tomographic scans. We compared survival in patients with and without the SUPRA pattern. Measurements and Main Results: The SUPRA FVL pattern occurred in 56% of the 89 patients who qualified for the analysis. The pTLC ratio of SUPRA and non-SUPRA patients was 1.11 and 0.99, respectively (P = 0.004). A higher pTLC ratio was correlated with increased probability of the SUPRA pattern (P = 0.0072). Airway luminal areas were larger in SUPRA patients (P = 0.009). Survival was better in the SUPRA cohort (P = 0.009). Conclusions: The SUPRA FVL pattern was frequent in BLT/HLT patients. High expiratory flows in SUPRA patients could result from increased lungelastic recoilor reduced airway resistance, both of which could be caused by the pTLC mismatch. Improved survival in the SUPRA cohort suggests potential therapeutic approaches to improve outcomes in BLT/HLT patients.

AB - Rationale: Flow volume loops (FVL) in some bilateral lung transplant (BLT) and heart-lung transplant (HLT) patients suggest variable extrathoracic obstruction in the absence of identifiable causes. These FVLs usually have supranormal expiratory and normal inspiratory flow rates (SUPRA pattern). Objectives: Characterize the relationship of the SUPRA pattern to predicted donor and recipient lung volumes, airway size, and survival. Methods: We performed a retrospective review of adult BLT/HLT patients. We defined the SUPRA FVL pattern as: (1) mid-vital capacity expiratory to inspiratory flow ratio (Ve50:Vi50) > 1.0, (2) absence of identifiable causes of extrathoracic obstruction, and (3) Ve50/FVC≥1.5 s 21. We calculated predicted total lung capacity (pTLC) ratio by dividing the donor pTLC by the recipient pTLC. We measured airway luminal areas on thoracic computer tomographic scans. We compared survival in patients with and without the SUPRA pattern. Measurements and Main Results: The SUPRA FVL pattern occurred in 56% of the 89 patients who qualified for the analysis. The pTLC ratio of SUPRA and non-SUPRA patients was 1.11 and 0.99, respectively (P = 0.004). A higher pTLC ratio was correlated with increased probability of the SUPRA pattern (P = 0.0072). Airway luminal areas were larger in SUPRA patients (P = 0.009). Survival was better in the SUPRA cohort (P = 0.009). Conclusions: The SUPRA FVL pattern was frequent in BLT/HLT patients. High expiratory flows in SUPRA patients could result from increased lungelastic recoilor reduced airway resistance, both of which could be caused by the pTLC mismatch. Improved survival in the SUPRA cohort suggests potential therapeutic approaches to improve outcomes in BLT/HLT patients.

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