An association of particulate air pollution and traffic exposure with mortality after lung transplantation in Europe

David Ruttens, Stijn E. Verleden, Esmée M. Bijnens, Ellen Winckelmans, Jens Gottlieb, Gregor Warnecke, Federica Meloni, Monica Morosini, Wim Van Der Bij, Erik A. Verschuuren, Urte Sommerwerck, Gerhard Weinreich, Markus Kamler, Antonio Roman, Susana Gomez-Olles, Cristina Berastegui, Christian Benden, Are Martin Holm, Martin Iversen, Hans Henrik SchultzBart Luijk, Erik Jan Oudijk, Johanna M. Kwakkel-Van Erp, Peter Jaksch, Walter Klepetko, Nikolaus Kneidinger, Claus Neurohr, Paul Corris, Andrew J. Fisher, James Lordan, Gerard Meachery, Davide Piloni, Elly Vandermeulen, Hannelore Bellon, Barbara Hoffmann, Danielle Vienneau, Gerard Hoek, Kees De Hoogh, Benoit Nemery, Geert M. Verleden, Robin Vos, Tim S. Nawrot, Bart M. Vanaudenaerde

Research output: Contribution to journalArticleResearchpeer-review

39 Citations (Scopus)


Copyright © ERS 2016. Air pollution from road traffic is a serious health risk, especially for susceptible individuals. Single-centre studies showed an association with chronic lung allograft dysfunction (CLAD) and survival after lung transplantation, but there are no large studies. 13 lung transplant centres in 10 European countries created a cohort of 5707 patients. For each patient, we quantified residential particulate matter with aerodynamic diameter ≤ 10 μm (PM10) by land use regression models, and the traffic exposure by quantifying total road length within buffer zones around the home addresses of patients and distance to a major road or freeway. After correction for macrolide use, we found associations between air pollution variables and CLAD/mortality. Given the important interaction with macrolides, we stratified according to macrolide use. No associations were observed in 2151 patients taking macrolides. However, in 3556 patients not taking macrolides, mortality was associated with PM10 (hazard ratio 1.081, 95% CI 1.000-1.167); similarly, CLAD and mortality were associated with road lengths in buffers of 200-1000 and 100-500 m, respectively (hazard ratio 1.085-1.130). Sensitivity analyses for various possible confounders confirmed the robustness of these associations. Long-term residential air pollution and traffic exposure were associated with CLAD and survival after lung transplantation, but only in patients not taking macrolides.
Original languageEnglish
JournalEuropean Respiratory Journal
Issue number1
Publication statusPublished - 1 Jan 2016


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