Forced expiratory volume in 1 second (FEV1 ) from spirometry, is the most commonly used parameter to detect early allograft dysfunction after lung transplantation (LTx). There are concerns regarding its sensitivity. Nitrogen-multiple breath washout (N2 -MBW) is sensitive at detecting early global (lung clearance index; LCI), and acinar (Sacin ) airway inhomogeneity. We investigated whether N2 -MBW indices indicate small airways pathology after LTx in children with stable spirometry. Thirty-seven children without BOS on median 1.6 (0.6-3.0) years after LTx, underwent N2 -MBW and spirometry, 28 of those on two occasions (=6 months apart) during clinically stable periods. Additional longitudinal data (11 and 8 measurements, respectively) are provided from two patients with BOS. In non-BOS patients, LCI and Sacin were significantly elevated compared to healthy controls. LCI was abnormal at the two test occasions in 81% and 71% of patients, respectively, compared to 30% and 39% of patients with abnormal FEV1 /FVC. Correlations of LCI with FEV1 /FVC (r=0.1, p=0.4) and FEV1 (r= -0.1, p=0.6) were poor. N2 -MBW represents a sensitive and reproducible tool for early detection of airways pathology in stable transplant recipients. Moreover, indices were highly elevated in both patients with BOS. Spirometry and LCI showed poor correlation, indicating distinct and complimentary physiological measures. This article is protected by copyright. All rights reserved.
- Nyilas, S.; Carlens, J.; Price, T.; Singer, F.; Muller, C.; Hansen, G.; Warnecke, G.; Latzin, P.; Schwerk, N.