Pre-operative and post-operative spirometry in bone marrow transplant patients.

Objective: To analyze the spirometry findings in patients undergoing bone marrow transplant, determining the importance of such findings in predicting postoperative pulmonary complications and looking for correlations with postoperative outcomes.

Methods: The spirometry findings in 120 male and female patients, all above the age of 12, were evaluated retrospectively and compared in terms of the following parameters: the type of bone marrow transplant; the underlying disease; cytomegalovirus serology; source of the transplanted cells; smoking; pulmonary infection; history of lung disease; duration of the hematological disease; chemotherapy employed; conditioning regimen; acute or chronic rejection of the transplant; and post-operative mortality.

Results: In the pre-operative spirometry, 16 patients (13.3%) presented alterations: 6 (5%) presented pure obstruction; 7 (5.8%) presented pure restriction; and 3 (2.5%) presented obstruction accompanied by a reduction in vital capacity. In the post-operative spirometry, 29 patients (24.2%) presented alterations. The chance of presenting post-operative spirometry alterations was greater in patients presenting acute transplant rejection (p = 0.02), patients older than 30 (p = 0.02), female patients (p = 0.02) and patients receiving stem cells (p = 0.01). Having a history of lung disease was found to be associated with greater mortality, as was suffering from chronic transplant rejection. No relationship was found between pre-operative spirometry alterations and post-operative mortality.

Conclusion: In bone marrow transplant patients, the alterations found through pre-operative spirometry were not predictive of post-operative pulmonary complications or mortality. Nor were such alterations determinant of whether or not a given patient was a good candidate for bone marrow transplant. Simple spirometry seems to be of little practical importance in the evaluation of such patients.