Lobe-wise assessment of lung volume and density distribution in lung transplant patients and value for early detection of bronchiolitis obliterans syndrome

Dettmer, Sabine; Suhling, Hendrik; Klingenberg, I.; O, Otten; Kaireit, Till F.; Fuge, Jan; Kuhnigk, J. M.; Gottlieb, Jens; Haverich, Axel; Welte, Tobias; Wacker, Frank; Vogel‐Claussen, Jens; Shin, Hoen‐oh

doi:10.1016/j.ejrad.2018.07.016

Cited by 14 publications

(13 citation statements)

References 30 publications

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“…Since FVC usually already decreases during subsequent BOS progression, we found an additional decline in FVC > 20% only in a minority of the patients. In contrast, TLC mostly remains stable or even increases following BOS diagnosis; therefore, a TLC decline ≥ 10% is evident in almost all patients when they evolve from BOS to the mixed phenotype. However, not the best postoperative TLC should be used to calculate this decline, but rather the last TLC available during BOS progression, as suggested by the new guidelines, since TLC usually increases in BOS patients .…”

Section: Discussionmentioning

confidence: 97%

“…In contrast, TLC mostly remains stable or even increases following BOS diagnosis; therefore, a TLC decline ≥ 10% is evident in almost all patients when they evolve from BOS to the mixed phenotype. However, not the best postoperative TLC should be used to calculate this decline, but rather the last TLC available during BOS progression, as suggested by the new guidelines, since TLC usually increases in BOS patients . Therefore, this favors performing routine plethysmography in the follow‐up of lung transplant patients, also after CLAD (BOS) has been diagnosed.…”

Section: Discussionmentioning

confidence: 97%

“…Since most studies performed so far have investigated the prog- 16 Therefore, this favors performing routine plethysmography in the follow-up of lung transplant patients, also after CLAD (BOS) has been diagnosed. This discrepancy between FVC and TLC decline to diagnose a phenotype evolution is likely to be explained by the increase in air trapping related to BOS progression, which can also lead to a decreased FVC in the absence of a TLC decline.…”

Section: Discussionmentioning

confidence: 99%

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Identification and characterization of chronic lung allograft dysfunction patients with mixed phenotype: A single‐center study

Verleden

Thüsen

Herck

et al. 2020

Clinical Transplantation

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Rationale Patients can change chronic lung allograft dysfunction (CLAD) phenotype, especially from BOS to mixed phenotype. Our aim was to further characterize these patients. Method Mixed CLAD was defined as a restrictive physiology with persistent CT opacities, after initial bronchiolitis obliterans syndrome (BOS) diagnosis. The incidence, prognosis, pulmonary function, radiology, pathology, and airway inflammation were compared between patients with restrictive allograft syndrome (RAS) and mixed CLAD. Result A total of 268 (44%) patients developed CLAD of which 47 (18%) were diagnosed with RAS “ab initio,” 215 (80%) with BOS, and 6 (2%) an undefined phenotype. Twenty‐five patients developed a mixed CLAD phenotype (24 BOS to mixed and 1 RAS to mixed). Survival after mixed phenotype diagnosis was comparable (P = .39) to RAS. More emphysema patients developed a mixed phenotype (P = .020) compared to RAS ab initio, while mixed CLAD patients had a lower FEV1 (P < .0001) and FEV1/FVC (P = .0002) at diagnosis compared to RAS ab initio. CT scans in patients with the mixed phenotype demonstrated apical predominance of the opacities (P = .0034) with pleuroparenchymal fibroelastosis on histopathology. Conclusion We further characterized patients with a mixed phenotype of CLAD. Although the survival after diagnosis was comparable to RAS ab initio patients, there was a difference in demography, pulmonary function, radiology, and pathology.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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Identification and characterization of chronic lung allograft dysfunction patients with mixed phenotype: A single‐center study

Verleden

Thüsen

Herck

et al. 2020

Clinical Transplantation

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“…92 Dynamic HRCT has been used to aid the diagnosis of BOS particularly when pulmonary function tests are normal: a mosaic oligemia pattern and expiratory air trapping may be seen; however, the sensitivity of CT-depicted air trapping before the clinical appearance of BOS is lower than has been previously reported. 93 Development of BOS is associated with the progressive irreversible decline in lung function and a poor response to therapeutic interventions. 94 Early changes in the pulmonary function can be one such marker.…”

Section: Posttransplant Bronchiolitismentioning

confidence: 99%

Bronchiolitis and Bronchiolar Disorders

Ravaglia¹,

Poletti

2020

Semin Respir Crit Care Med

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Bronchioles are noncartilaginous small airways with internal diameter of 2 mm or less, located from approximately the eighth generation of purely air conducting airways (membranous bronchioles) down to the terminal bronchioles (the smallest airways without alveoli) and respiratory bronchioles (which communicate directly with alveolar ducts and are in the range of 0.5 mm or less in diameter). Bronchiolar injury, inflammation, and fibrosis may occur in myriad disorders including connective tissue diseases, inflammatory bowel diseases, lung transplant allograft rejection, graft versus host disease in allogeneic stem cell recipients, neuroendocrine cell hyperplasia, infections, drug toxicity (e.g., penicillamine, busulfan), inhalation injury (e.g., cigarette smoke, nylon flock, mineral dusts, hard metals, Sauropus androgynous); idiopathic, common variable immunodeficiency disorder, and a host of other disorders or insults. The spectrum of bronchiolar disorders is wide, ranging from asymptomatic to fatal obliterative bronchiolitis. In this review, we discuss the salient clinical, radiographic, and histological features of these diverse bronchiolar disorders, and discuss a management approach.

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“…Long-term survival after lung transplantation (LT) is often hampered by chronic lung allograft dysfunction (CLAD), which is believed to reflect chronic rejection [1,2]. CLAD, a term used to refer to all variants of pulmonary chronic dysfunction, affects up to 50% of lung transplant recipients within five years after surgery [3], and bronchiolitis obliterans syndrome (BOS) is the most common manifestation of CLAD [2]. Proposed by the Committee of the International Society for Heart and Lung Transplantation (ISHLT), the term BOS is a clinical description of bronchiolitis obliterans (BO), a histopathologic entity characterized by a fibroproliferative process of the small airways with multifocal obliteration of the terminal bronchiole [4].…”

Section: Introductionmentioning

confidence: 99%

Utilization of Quantitative Computed Tomography Assessment to Identify Bronchiolitis Obliterans Syndrome After Single Lung Transplantation

Nascimento

Watte²,

Torres

et al. 2021

Lung

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Objective To evaluate quantitative chest computed tomography (CT) methods for the detection of air trapping (AT) and to assess its diagnostic performance for the diagnosis of bronchiolitis obliterans syndrome (BOS) in single lung transplant (SLT) patients. Methods Adult patients who had a SLT at a single transplant center and underwent CT scan after transplantation were retrospectively included. CT findings of air trapping were measured by three different methods: expiratory air-trapping index (ATIexp), mean lung density on expiratory acquisition (MLDexp) and expiratory to inspiratory ratio of mean lung density (E/I-ratio(MLD). Sensitivity, specificity and diagnostic accuracy of the three methods for the detection of BOS status evaluated by serial routine measures of pulmonary function tests (gold standard) were assessed. Results Forty-six SLT patients (52.2% females, mean age 58 ± 6 years) were included in the analysis, 12 (26%) patients with a diagnosis of BOS. Quantitative CT diagnosis of AT ranged from 26 to 35%. Sensitivity, specificity and accuracy of each method for the detection of BOS were 85.7%, 84.7% and 85.0% for ATIexp, 78.5%, 93.4% and 90.0% for MLD and 64.2%, 89.1% and 83.3% E/I-ratio(MLD), respectively. Conclusion Quantitative measures of AT obtained from standard CT are feasible and show high specificity and accuracy for the detection of BOS in SLT patients.

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Lobe-wise assessment of lung volume and density distribution in lung transplant patients and value for early detection of bronchiolitis obliterans syndrome

Cited by 14 publications

References 30 publications

Identification and characterization of chronic lung allograft dysfunction patients with mixed phenotype: A single‐center study

Identification and characterization of chronic lung allograft dysfunction patients with mixed phenotype: A single‐center study

Bronchiolitis and Bronchiolar Disorders

Utilization of Quantitative Computed Tomography Assessment to Identify Bronchiolitis Obliterans Syndrome After Single Lung Transplantation

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