Objective: Chronic allograft disease after lung transplantation (CLAD) remains one of the major
problems in long-term cause of these patients. Home spirometry is routinely used for
the assessment of acute pulmonary events and the development of CLAD. Nevertheless
the evidence for home spirometry in lung transplantation is rare. The aim of this
study was to analyze the clinical impact of home spirometry in patients with CLAD.
Methods: We analyzed the home spirometry data (62,180 measurements) of 37 patients after lung
transplantation during a mean observation time of 27.6 months. Patient demographics,
acute pulmonary events, and development auf CLAD on the basis of standard FEV1-Baseline
(1 peak measurement) were evaluated. Additionally the development auf CLAD was calculated
using an alternative FEV1-Baseline (arithmetic mean of the 10 best 3-day medians).
To determine a clinical impact regression analysis was performed.
Results: The patients were 42.2 ± 16.3 years of age (62.5% male). Indications for lung transplantation
were fibrosis (29.7%), cystic fibrosis (24.3%), COPD (32.4%), CLAD (5.4%, Re-Tx),
Eisenmenger syndrome (5.4%, HLTX), and sarcoidosis (2.7%). Freedom of CLAD (≤ stadium
1) calculated with standard Baseline were 426.7 ± 103.8 days. Freedom of CLAD (≤ stadium
1) calculated with the alternative FEV1-Baseline were significantly (p = 0.003, 216%) longer (922.5 ± 141.3 days). In regression analysis, CLAD stadium
calculated with the alternative FEV1-Baseline was the only significant risk factor
for occurrence of acute pulmonary events (p=0,041) and poor recovery (p = 0.020) in our population.
Conclusion: Home spirometry is an important tool to assess CLAD in the long-term medical care
after lung transplantation. A significant clinical impact is only detectable if our
alternative FEV1-Baseline is used for calculating the CLAD stadium.
