LAUSR

Long-term survival after lung transplantation (LTx) is hampered by chronic lung allograft dysfunction, with bronchiolitis obliterans syndrome (BOS) as its most common phenotype. We investigated whether development and timing of bronchiectasis (BRECT) has prognostic significance in BOS patients. Patients transplanted between 2004-2015 with a survival of >90 days who developed BOS (n=124) were included. BOS was defined as a persistent FEV₁ decline of ≥20% compared to baseline, in absence of restrictive pulmonary function tests or persistent infiltrates. BOS patients were retrospectively classified according to presence and timing of BRECT development (before vs. after BOS diagnosis) using chest CT during follow-up. Primary outcomes were overall survival and post-BOS survival. In 36% of BOS patients BRECT were identified, of which 24% developed BRECT at a median of 331 days before BOS and 76% at a median of 654 days after BOS diagnosis. Patients who developed BRECT after BOS, had worse overall (p=0.0031) and post-BOS (p=0.030) survival compared to those without BRECT. Patients who developed BRECT before BOS, had similar overall (p=0.40) and post-BOS survival (p=0.52) compared to those without BRECT. BOS patients with BRECT had more infections (p=0.0030) and were more colonized with Pseudomonas Aeruginosa (p=0.013) compared to those without BRECT. Development and timing of BRECT has prognostic significance in BOS.