Oscillometry in Stable Single and Double Lung Allograft Recipients Transplanted for Interstitial Lung Disease: Results of a Multi-Center Australian Study

Peak spirometry after single lung transplantation (SLTx) for interstitial lung disease (ILD) is lower than after double lung transplantation (DLTx), however the pathophysiologic mechanisms are unclear. We aim to assess respiratory mechanics in SLTx and DLTx for ILD using oscillometry. Spirometry and oscillometry (tremoflo (R) C-100) were performed in stable SLTx and DLTx recipients in a multi-center study. Resistance (R-5, R5-19) and reactance (X-5) were compared between LTx recipient groups, matched by age and gender. A model of respiratory impedance using ILD and DLTx data was performed. In total, 45 stable LTx recipients were recruited (SLTx n = 23, DLTx n = 22; males: 87.0% vs. 77.3%; median age 63.0 vs. 63.0 years). Spirometry was significantly lower after SLTx compared with DLTx: %-predicted mean (SD) FEV1 [70.0 (14.5) vs. 93.5 (26.0)%]; FVC [70.5 (16.8) vs. 90.7 (12.8)%], p < 0.01. R-5 and R5-19 were similar between groups (p = 0.94 and p = 0.11, respectively) yet X-5 was significantly worse after SLTx: median (IQR) X-5 [-1.88 (-2.89 to -1.39) vs. -1.22 (-1.87 to -0.86)] cmH(2)O.s/L], p < 0.01. R-5 and X-5 measurements from the model were congruent with measurements in SLTx recipients. The similarities in resistance, yet differences in spirometry and reactance between both transplant groups suggest the important contribution of elastic properties to the pathophysiology. Oscillometry may provide further insight into the physiological changes occurring post-LTx.

Automated summary

This study assessed respiratory mechanics in patients with interstitial lung disease after single lung transplantation and double lung transplantation. The results showed that lung function was significantly lower after single lung transplantation compared to double lung transplantation, while resistance was similar but reactance was significantly worse. The model results were consistent with the actual measurements. These findings suggest the important role of elastic properties in the pathophysiology, and oscillometry may provide further insight into physiological changes after transplantation.