Lung transplantation · Monitoring the allograft
Trajectories of FEV1 after lung transplantation and patient outcomes
| Design | Multicentre cohort study with development and validation cohorts |
|---|---|
| Treatment | Latent class modelling of serial FEV1 measurements |
| Control | None — single-cohort latent class analysis, with external validation cohorts |
| Population | 2305 lung transplant recipients contributing 59,034 FEV1 measurements, median follow-up 4.3 years |
| Follow-up | Median 4.3 years |
| Primary endpoint | Association of FEV1 trajectory class with post-transplant outcomes |
| Result | Seven clinically meaningful FEV1 trajectories were identified in the development cohort of 605 patients and reproduced in external validation cohorts. Three-year survival ranged from 79.9% in the moderate-and-stable trajectory (25.6% of patients) to 33.3% in the worst accelerated-decline trajectory. Trajectory membership was associated with sex (p=0.020) and underlying disease (p=0.004), and FEV1 value and slope at one year were strongly predictive of trajectory. |
| Secondary endpoints | Survival by trajectory class, relation to chronic lung allograft dysfunction |
We identified and validated FEV1 trajectories that capture different clinical scenarios associated with post-transplant recipient outcomes. Our results may provide the basis for a trajectory-based risk assessment of lung transplant recipients.
The trial authors, in the published abstract
Proposes replacing a threshold-based definition of allograft dysfunction with the shape of the decline — using nearly 60,000 measurements to do it. Descriptive rather than interventional, so its value depends on whether the classes turn out to have different treatments.
Raynaud M, Belousova N, Glorion M, et al. Trajectories of FEV(1) after lung transplantation and patient outcomes. J Heart Lung Transplant 2025 Nov;44(11):1749-1762.