Effect of Adherence to Home Spirometry on Bronchiolitis Obliterans and Graft Survival After Lung Transplantation
Abstract
BACKGROUND: Patient-controlled home spirometry (HS) after lung transplantation has been shown to be valid and reliable to detect the presence of graft infection and rejection at its earliest onset. Effects of nonadherence to HS on detection of the bronchiolitis obliterans syndrome (BOS) and on graft survival are unknown. METHODS: A 7-year prospective cohort study assessed nonadherence longitudinally using electronic spirometry for 24 months. During follow-up, BOS, retransplantation, and survival were stratified by adherence groups. RESULTS: Electronic monitoring of 226 patients confirmed that 123,487 measures were performed. Period prevalence was 0.76 measures per patient day and decreased significantly over time (P<0.0001). During follow-up, BOS was developed in 32% of patients; 5% received a second transplant, and mortality rate was 19%. Kaplan-Meier event-free analysis showed decreased freedom from BOS time in nonadherers (30%) compared with good (43%) or moderate adherers (19%) (log rank 6.008; P<0.014) and a tendency toward lower retransplantation rates (log rank 3.14; P<0.07). Mantel Cox regression revealed no impact of adherence on patient survival. CONCLUSIONS: This was the first study assessing nonadherence to HS based on electronic monitoring in relation to long-term outcome after lung transplantation. Nonadherers showed decreased freedom from BOS in the largest sample to date, but did not impact survival.
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We have previously published the association of non-adherence with home spirometry and chronic lung allograft dysfunction (CLAD) in LTx recipients.
“We have previously published the association of non-adherence with home spirometry and chronic lung allograft dysfunction (CLAD) in LTx recipients[12].”
From Adherence is associated with a favorable outcome after lung transplantation (2019) · cites this paper as [12]
Regular home spirometry failed to reach a statistically significant association with patient and allograft survival in this study.
“Regular home spirometry failed to reach a statistically significant association with patient and allograft survival in this study, which is in line with our former work that could only demonstrate an association with CLAD-free survival[12].”
From Adherence is associated with a favorable outcome after lung transplantation (2019) · cites this paper as [12]
Adherence score items were chosen by being objectively measurable and distinct categories of adherence based on normal distribution and interim results of LTx outpatients in a training period of 3 months in early 2009, and levels were based on previously published cut-offs.
“Items were chosen by being objectively measurable and distinct categories of adherence based on normal distribution and interim results of LTx outpatients in a training period of 3 months in early 2009 and levels were based on previously published cut-offs[12].”
From Adherence is associated with a favorable outcome after lung transplantation (2019) · cites this paper as [12]
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Self-citation
- Authors
- Kugler, C., Fuehner, T., Dierich, M., DeWall, C., Haverich, A., Simon, A., Welte, T., & Gottlieb, J.
- Affiliations
- Medizinische Hochschule Hannover (DE)
- Corresponding author
- Kugler, Christiane
- Venue
- Transplantation
- Published
- 2009-07-15
- Volume
- 88
- Issue
- 1
- Pages
- 129-134
- ISSN
- 0041-1337 (ISSN-L)
- OpenAlex
- W2005830471
- Cited by
- 50
- References
- 30
- Citations by year
- 2026: 2 · 2025: 4 · 2023: 1 · 2022: 3 · 2021: 2 · 2020: 6 · 2019: 3 · 2018: 6 · 2017: 2 · 2016: 4 · 2015: 2 · 2014: 5 · 2013: 4 · 2012: 1
- FWCI
- 2.02
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Transplantation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
- Keywords
- home spirometry, patient adherence, bronchiolitis obliterans syndrome, lung transplantation, graft survival, retransplantation, post-transplant lung disease
- MeSH terms
- Adolescent, Adult, Aged, Bronchiolitis Obliterans, Female, Graft Rejection, Graft Survival, Humans, Male, Middle Aged, Patient Compliance, Predictive Value of Tests, Prospective Studies, Reoperation, Self Care, Spirometry, Time Factors, Proportional Hazards Models, Lung Transplantation, Risk Assessment, Early Diagnosis, Kaplan-Meier Estimate, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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