Article Text

The impact of traffic air pollution on bronchiolitis obliterans syndrome and mortality after lung transplantation
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  1. Tim S Nawrot1,2,
  2. Robin Vos3,4,
  3. Lotte Jacobs2,
  4. Stijn E Verleden3,4,
  5. Shana Wauters4,
  6. Veerle Mertens4,
  7. Christophe Dooms3,
  8. Peter H Hoet2,
  9. Dirk E Van Raemdonck4,5,
  10. Christel Faes6,
  11. Lieven J Dupont3,4,
  12. Benoit Nemery2,
  13. Geert M Verleden3,4,
  14. Bart M Vanaudenaerde3,4
  1. 1Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
  2. 2School of Public Health, Lung Toxicology Unit, Katholieke Universiteit Leuven and University Hospital Gasthuisberg, Leuven, Belgium
  3. 3Laboratory of Pneumology, Katholieke Universiteit Leuven and University Hospital Gasthuisberg, Leuven, Belgium
  4. 4Lung Transplantation Unit, Katholieke Universiteit Leuven and University Hospital Gasthuisberg, Leuven, Belgium
  5. 5Department of Thoracic Surgery, Katholieke Universiteit Leuven and University Hospital Gasthuisberg, Leuven, Belgium
  6. 6Interuniversity Institute of Biostatistics, Hasselt University, Diepenbeek, Belgium
  1. Correspondence to Dr Bart M Vanaudenaerde, Labo Pneumologie, Box 706, Katholieke Universiteit Leuven, 49 Herestraat, B-3000 Leuven, Belgium; bart.vanaudenaerde{at}med.kuleuven.be

Abstract

Background Approximately half of all patients who underwent a lung transplantation suffer from bronchiolitis obliterans syndrome (BOS), the clinical correlate of chronic rejection, within 5 years after transplantation. This prevalence is much higher than for other solid organ transplantations, possibly due to the lung's direct contact with the environment. The authors assessed the association between proximity of the home to major roads and BOS and mortality in a cohort of patients after lung transplantation.

Methods The authors calculated hazard ratios for BOS and mortality in relation to proximity of the home to major roads, adjusting for relevant covariables, in 288 patients after lung transplantation at the Leuven University Hospital between 1997 and 2009 and with follow-up until August 2009. Inflammatory parameters in plasma and bronchoalveolar lavage were assessed in 207 patients.

Results During follow-up, 117 (41%) patients developed BOS and 61 (21%) died. Patients who lived within 171 m of a major road (lowest tertile) were 2.06 (95% CI 1.39 to 3.05) times more likely to develop BOS and 2.20 (1.25 to 3.86) times more likely to die than patients living farther away. The adjusted hazard ratios of BOS and mortality were 0.57 and 0.72 for each 10-fold increase in distance from major roads. Proximity to a major road was inversely associated with plasma C-reactive protein levels, neutrophil percentage and interleukin-6 concentration in bronchoalveolar lavage.

Conclusion Traffic-related air pollution appears to constitute a serious risk of BOS and mortality after lung transplantation.

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Supplementary materials

  • Web Only Data thx.2010.155192

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Footnotes

  • See Editorial, p 742

  • Linked article 159525.

  • Funding GMV is holder of the GSK (Belgium) chair in respiratory pharmacology at the KULeuven, and is supported by the Research Foundation Flanders (FWO): G.0643.08 and G.0723.10 and `Onderzoeksfonds K.U.Leuven (OT/10/050). RV is a research fellow and BMV, DEVR and LJD are senior research fellows of the FWO. The environmental health research at Hasselt University is supported by the FWO (1.5.158.09.N.00) and Internal UHasselt University grants (Bijzonder Onderzoekdsfonds, BOF).

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Ethical Review Board of the Leuven University Medical Faculty.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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