The impact of long-term air pollution and traffic on outcome after lung transplantation in Europe

It has been suggested that air pollution influences survival after lung transplantation (LTx).We investigated the association of long-term exposure to fine particles and traffic with mortality and chronic lung allograft dysfunction (CLAD).In 13 European LTx centers, patient characteristics were retrospectively collected. Patients transplanted 700 km from LTx center were excluded, resulting in 5,707 LTx patients. We estimated long-term particulate matter (PM 10 ) exposure at home addresses with temporally adjusted land-use regression models and total road length within buffers zones around the home and using Cox regression. We associated this with incidence of CLAD and mortality, separately for patients taking macrolides or not. During follow-up (median 4.2 y), 2,767 patients developed CLAD and 2,718 died. In patients not taking AZI (n=3,551) air-pollution was associated with mortality and CLAD independent of covariates.The risk for dying increased by 22.0% for patients living in an area above the WHO air pollution standards (20 µg/m³) compared with residence <20 µg/m³. The density of roads within a 50-to-500m buffer zone around the home address was also associated with mortality and CLAD. No associations were observed in the macrolide-group (n=2,156).Air pollution is associated with worse prognosis after LTx and macrolides may prevent air pollution induced mortality.