Functional and computed tomographic evolution and survival of restrictive allograft syndrome after lung transplantation

Verleden, Stijn E.; Jong, Pim A. de; Ruttens, David; Vandermeulen, Elly; Raemdonck, Dirk Van; Verschakelen, Johny; Vanaudenaerde, Bart M.; Verleden, Geert M.; Vos, Robin

doi:10.1016/j.healun.2013.12.011

Cited by 59 publications

(43 citation statements)

References 13 publications

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“…The land-mark study of Sato et al showed an apical predominance in a significant subset of patients (13), which was in line with the earlier observation of upper-lobe dominant fibrosis post-lung transplantation (52). However, we recently demonstrated that there are also patients with diffuse or basal-dominated infiltrates on CT and interestingly, these patients had a worse outcome compared to patients with apical dominated fibrosis (51), while the degree of consolidation, ground glass or reticulation did not correlate with survival post diagnosis (53). CT could also be used as alternative tool to diagnose rCLAD, as lungs have significantly lower lung volume compared to baseline, while the volume of lungs in BOS remains stable or even increases (54).…”

Section: Diagnosis Radiology and Pathologysupporting

confidence: 90%

Chronic lung allograft dysfunction phenotypes and treatment

et al. 2017

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CT and obliterative bronchiolitis (OB) on histopathology, while RAS/rCLAD patients show a restrictive pulmonary function, persistent pleuro-parenchymal infiltrates on CT and pleuroparenchymal fibro-elastosis on biopsies. Importantly, the patients with RAS/rCLAD have a severely limited survival post diagnosis of 6-18 months compared to 3-5 years after BOS diagnosis. In this review, we will review historical evidence for this heterogeneity and we will highlight the clinical, radiological, histopathological characteristics of both phenotypes, as well as their risk factors. Treatment of CLAD remains troublesome, nevertheless, we will give an overview of different treatment strategies that have been tried with some success. Adequate phenotyping remains difficult but is clearly needed for both clinical and scientific purposes.

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Section: Diagnosis Radiology and Pathologysupporting

confidence: 90%

Chronic lung allograft dysfunction phenotypes and treatment

et al. 2017

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“…Higher BOS grades and transition from lower to higher grades have been shown to correlate with worsened survival (30,31). Recent data have also used TLC and radiographic changes to characterize subsets with poor survival (8,32). However, full pulmonary function testing is not routinely performed for graft surveillance, and radiographic interpretations can vary; presently no specific guidelines or consensus exist regarding use of highresolution computed tomography other than ruling out confounding variables (33).…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Forced Vital Capacity Monitoring as a Prognostic Adjunct after Lung Transplantation

Belloli

Wang

Murray

et al. 2015

Am J Respir Crit Care Med

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Rationale: After lung transplantation, spirometric values are routinely followed to assess graft function. FEV 1 is used to characterize chronic allograft dysfunction, whereas the course of FVC change has been less acknowledged and rarely used.Objectives: To better understand the temporal relationship and prognostic ability of FEV 1 and FVC decline after lung transplantation.Methods: Serial FEV 1 and FVC values were studied among 205 bilateral lung transplant recipients. Different decline patterns were characterized and evaluated for prognostic value via restricted mean modeling of mortality and times to other pertinent events.Measurements and Main Results: Baseline FEV 1 was achieved earlier than baseline FVC (median, 296 vs. 378 d; P , 0.0001). Decline in FEV 1 or FVC from their respective post-transplant baselines occurred in 85 patients (41%). Fifty-nine of 85 (69%) had an isolated FEV 1 decline, with 80% later meeting the FVC decline criterion. This subsequent FVC decline was associated with worsening FEV 1 and lower median survival. Twenty-five of 85 patients (29%) demonstrated concurrent FEV 1 and FVC decline. Patients with concurrent decline had higher 1-and 5-year mortality rates (1-yr, 53% vs. 18%, P , 0.0001; 5-yr, 61% vs. 48%, P = 0.001).These patients were more likely to have rapid-onset of spirometry decline (P = 0.05) and lower FEV 1 % predicted (P = 0.04) at presentation.Conclusions: FVC decline from its post-transplant baseline provides valuable prognostic information. Concurrent FEV 1 and FVC decline identifies patients with fulminant, rapid deterioration and is the strongest clinical predictor of poor survival. Subsequent FVC decline in patients with an initial isolated FEV 1 decline identifies disease progression and portends poor prognosis.

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“…Regarding aetiology, the majority of PPFE cases (.50%) have been reported as a late complication of bone marrow/haematopoietic stem cell [2,6] and lung transplantation [2,6,40], for which the terms ''upper lobe fibrosis'' [29,40] and ''chronic lung allograft dysfunction'' [41] have been applied. The prevalence of PPFE in lung transplant recipients may be as high as 2% [29].…”

Section: @Erspublicationsmentioning

confidence: 99%