Clinical staging of chronic rejection in lung transplantation using home spirometry

Clinical staging of chronic rejection in transplanted lungs has been evaluated in a group of transplant recipients using a paperless, electronic spirometer/diary instrument for home monitoring. Five of 60 subjects doing home monitoring were diagnosed with chronic rejection. Clinic and home spirometry variables were used in the staging algorithm to determine the onset and rate of clinical decline related to the rejection. Clinic and home FEV1 provided comparable onset and rates of decline; home FEF/sub 25%-75%/ detected onset from 65-477 days earlier than either FEV1 measure, and was more sensitive to declining function than FEV1. Detection of chronic rejection can be achieved with the home monitor, and home FEF/sub 25%-75%/ provides a new indicator that should be considered in future staging systems.