Bronchiolitis obliterans syndrome–free survival after lung transplantation: An International Society for Heart and Lung Transplantation Thoracic Transplant Registry analysis

Hrishikesh S. Kulkarni, Wida S. Cherikh, Daniel C. Chambers, Victoria C. Garcia, Ramsey R. Hachem, Daniel Kreisel, Varun Puri, Benjamin D. Kozower, Derek E. Byers, Chad A. Witt, Jennifer Alexander-Brett, Patrick R. Aguilar, Laneshia K. Tague, Yuka Furuya, G. Alec Patterson, Elbert P. Trulock, Roger D. Yusen

Research output: Contribution to journalArticlepeer-review

88 Scopus citations


BACKGROUND: Lung transplant (LTx) recipients have low long-term survival and a high incidence of bronchiolitis obliterans syndrome (BOS). However, few long-term, multicenter, and precise estimates of BOS-free survival (a composite outcome of death or BOS) incidence exist. METHODS: This retrospective cohort study of primary LTx recipients (1994–2011) reported to the International Society of Heart and Lung Transplantation Thoracic Transplant Registry assessed outcomes through 2012. For the composite primary outcome of BOS-free survival, we used Kaplan-Meier survival and Cox proportional hazards regression, censoring for loss to follow-up, end of study, and re-LTx. Although standard Thoracic Transplant Registry analyses censor at the last consecutive annual complete BOS status report, our analyses allowed for partially missing BOS data. RESULTS: Due to BOS reporting standards, 99.1% of the cohort received LTx in North America. During 79,896 person-years of follow-up, single LTx (6,599 of 15,268 [43%]) and bilateral LTx (8,699 of 15,268 [57%]) recipients had a median BOS-free survival of 3.16 years (95% confidence interval [CI], 2.99–3.30 years) and 3.58 years (95% CI, 3.53–3.72 years), respectively. Almost 90% of the single and bilateral LTx recipients developed the composite outcome within 10 years of transplantation. Standard Registry analyses “overestimated” median BOS-free survival by 0.42 years and “underestimated” the median survival after BOS by about a half-year for both single and bilateral LTx (p < 0.05). CONCLUSIONS: Most LTx recipients die or develop BOS within 4 years, and very few remain alive and free from BOS at 10 years post-LTx. Less inclusive Thoracic Transplant Registry analytic methods tend to overestimate BOS-free survival. The Registry would benefit from improved international reporting of BOS and other chronic lung allograft dysfunction (CLAD) events.

Original languageEnglish (US)
Pages (from-to)5-16
Number of pages12
JournalJournal of Heart and Lung Transplantation
Issue number1
StatePublished - Jan 2019

Bibliographical note

Publisher Copyright:
© 2018 Elsevier Ltd


  • BOS-free survival
  • bronchiolitis obliterans syndrome
  • chronic lung allograft dysfunction
  • ISHLT Registry
  • lung transplant
  • Follow-Up Studies
  • Heart-Lung Transplantation
  • Humans
  • Middle Aged
  • Male
  • Bronchiolitis Obliterans/epidemiology
  • Incidence
  • Young Adult
  • Disease-Free Survival
  • Survival Rate/trends
  • United States/epidemiology
  • Lung Transplantation/adverse effects
  • Adult
  • Female
  • Registries
  • Aged
  • Retrospective Studies
  • Societies, Medical/statistics & numerical data

PubMed: MeSH publication types

  • Research Support, Non-U.S. Gov't
  • Multicenter Study
  • Journal Article
  • Research Support, N.I.H., Extramural


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