Pretransplant Lung Function, Respiratory Failure, and Mortality after Stem Cell Transplantation

• Published in: American journal of respiratory and critical care medicine 2005-08, Vol.172 (3), p.384-390
• Main Authors: Parimon, Tanyalak, Madtes, David K, Au, David H, Clark, Joan G, Chien, Jason W
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anemia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Gas Analysis; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Cancer research; Carbon monoxide; Emergency and intensive respiratory care; F. Transplantation; Female; Graft versus host disease; Hematologic Diseases - mortality; Hematologic Diseases - therapy; Humans; Intensive care medicine; Leukemia; Lung - physiopathology; Lung Volume Measurements; Lymphoma; Male; Medical research; Medical sciences; Middle Aged; Mortality; Patients; Pepper spray; Preoperative Care; Proportional Hazards Models; Respiratory failure; Respiratory Insufficiency - etiology; Respiratory Insufficiency - mortality; Respiratory Insufficiency - physiopathology; Retrospective Studies; Stem cell transplantation; Stem Cell Transplantation - adverse effects; Stem Cell Transplantation - mortality; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation, Homologous; Washington - epidemiology
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.200502-212OC

The role of pulmonary function before stem cell transplant as a potential risk factor for the development of early post-transplant respiratory failure and mortality is controversial. We conducted a retrospective analysis of the pretransplant pulmonary function of 2,852 patients who received their transplant between 1990 and 2001. Pretransplant FEV(1), FVC, total lung capacity (TLC), diffusing capacity of carbon monoxide (DL(CO)), and the alveolar-arterial oxygen tension difference P(A-a)O(2) were measured and assessed for association with development of early respiratory failure and mortality in Cox proportional hazard logistic models. In multivariate analyses, progressive decrease of all lung function parameters was associated with a stepwise increase in risk of developing early respiratory failure and mortality when assessed in independent models. On the basis of a significant correlation between FEV(1) and FVC (r = 0.81), FEV(1) and TLC (r = 0.61), and FVC and TLC (r = 0.80), and a lack of correlation between FEV(1) and DL(CO), we developed a pretransplant lung function score based on pretransplant FEV(1) and DL(CO) to determine the extent of pulmonary compromise before transplant. Multivariate analysis indicated that higher pretransplant lung function scores are associated with a significant increased risk for developing early respiratory failure (category II hazard ratio [HR], 1.4; category III HR, 2.2; category IV HR, 3.1; p < 0.001) and death (category II HR, 1.2; category III HR, 2.2; category IV HR, 2.7; p < 0.005). These results suggest that not only does compromised pretransplant lung function contribute to the risk for development of early respiratory failure and mortality but this risk may be estimated before transplant by grading the extent of FEV(1) and DL(CO) compromise.