Effect of native lung disease on post-transplant best lung function

Lung transplantation offers a life-saving treatment for patients with end-stage obstructive and restrictive lung diseases. However, differences in native lung disease types may influence post-transplant pulmonary function. This study evaluates the impact of native obstructive versus restrictive lung diseases on post-transplant best Forced Expiratory Volume in 1 s (FEV1) and Forced Vital Capacity (FVC).

We conducted a retrospective cohort study of adult bilateral lung transplant recipients at Mayo Clinic Rochester from January 2009 to December 2021. Patients were categorized into obstructive and restrictive groups based on pre-transplant diagnoses. The primary outcomes were post-transplant best FEV1 and FVC Z-scores, defined as the average of the two highest values obtained at least three weeks apart. Statistical comparisons were performed using independent sample t-tests, Kaplan-Meier survival curves, and multivariable linear regression models.

Of the 148 patients included, 46 had obstructive and 102 had restrictive lung diseases. Patients with restrictive lung disease achieved lower post-transplant best FEV1 (Z-score: 0.70, p = 0.01) and FVC (Z-score: 0.61, p = 0.04) compared to those with obstructive lung disease. The restrictive group reached post-transplant best FVC significantly earlier (median: 142 days vs. 297 days, p = 0.03). After adjusting for donor and recipient characteristics, the type of native lung disease was not significantly associated with post-transplant best lung function.

Native restrictive lung disease is associated with lower post-transplant lung function compared to obstructive lung disease. However, when adjusting for other factors, native lung disease type does not independently predict post-transplant best FEV1 or FVC.