Parametric Response Mapping as an Imaging Biomarker in Lung Transplant Recipients

Belloli, Elizabeth A.; Degtiar, Irina; Wang, Xin; Yanik, Gregory A.; Stuckey, Linda J.; Verleden, Stijn E.; Kazerooni, Ella A.; Ross, Brian D.; Murray, Susan; Galbán, Craig J.; Lama, Vibha N.

doi:10.1164/rccm.201604-0732oc

Cited by 59 publications

(56 citation statements)

References 44 publications

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“…In addition, our findings also showed that quantitative CT density analysis can evaluate the difference in survival within the individual diseased groups (RAS and BOS). Previously, similar results were found by Belloli et al using CT images with the PRM technique. Although we did not analyze the expiratory CT as the Belloli group did, we also found that quantitative CT density analysis can be a good imaging biomarker for evaluating CLAD, RAS, and BOS patient survival.…”

Section: Discussionsupporting

confidence: 86%

Quantitative chest CT for subtyping chronic lung allograft dysfunction and its association with survival

Horie

Salazar²,

Saito

et al. 2018

Clinical Transplantation

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Chronic lung allograft dysfunction (CLAD) is a major cause of mortality in lung transplant recipients. CLAD can be sub-divided into at least 2 subtypes with distinct mortality risk characteristics: restrictive allograft syndrome (RAS), which demonstrates increased overall computed tomography (CT) lung density in contrast with bronchiolitis obliterans syndrome (BOS), which demonstrates reduced overall CT lung density. This study aimed to evaluate a reader-independent quantitative density metric (QDM) derived from CT histograms to associate with CLAD survival. A retrospective study evaluated CT scans corresponding to CLAD onset using pulmonary function tests in 74 patients (23 RAS, 51 BOS). Two different QDM values (QDM1 and QDM2) were calculated using CT lung density histograms. Calculation of QDM1 includes the extreme edges of the histogram. Calculation of QDM2 includes the central region of the histogram. Kaplan-Meier analysis and Cox regression analysis were used for CLAD prognosis. Higher QDM values were significantly associated with decreased survival. The hazard ratio for death was 3.2 times higher at the 75th percentile compared to the 25th percentile using QDM1 in a univariate model. QDM may associate with CLAD patient prognosis.

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Section: Discussionsupporting

confidence: 86%

Quantitative chest CT for subtyping chronic lung allograft dysfunction and its association with survival

Horie

Salazar²,

Saito

et al. 2018

Clinical Transplantation

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“…Change in FEV 1 has been the standard by which BOS is defined despite the fact that it is relatively insensitive to changes in the peripheral airways. There are very few studies that have evaluated different lung function parameters for monitoring allograft function after LTx, with the majority having only adult cohorts . A previous longitudinal study in lung transplanted adults revealed that a concurrent FEV 1 and FVC decline from baseline is associated with fulminant rapid deterioration and a poor prognosis .…”

Section: Discussionmentioning

confidence: 99%

Multiple breath washout in pediatric patients after lung transplantation

Nyilas

Carlens²,

Price³

et al. 2018

American Journal of Transplantation

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Forced expiratory volume in 1 second (FEV ) from spirometry is the most commonly used parameter to detect early allograft dysfunction after lung transplantation (LTx). There are concerns regarding its sensitivity. Nitrogen-multiple breath washout (N -MBW) is sensitive at detecting early global (lung clearance index [LCI]) and acinar (S ) airway inhomogeneity. We investigated whether N -MBW indices indicate small airways pathology after LTx in children with stable spirometry. Thirty-seven children without bronchiolitis obliterans syndrome [BOS] at a median of 1.6 (0.6-3.0) years after LTx underwent N -MBW and spirometry, 28 of those on 2 occasions (≤6 months apart) during clinically stable periods. Additional longitudinal data (11 and 8 measurements, respectively) are provided from 2 patients with BOS. In patients without BOS, LCI and S were significantly elevated compared with healthy controls. LCI was abnormal at the 2 test occasions in 81% and 71% of patients, respectively, compared with 30% and 39% of patients with abnormal FEV /forced vital capacity (FVC). Correlations of LCI with FEV /FVC (r = 0.1, P = .4) and FEV (r = -0.1, P = .6) were poor. N -MBW represents a sensitive and reproducible tool for the early detection of airways pathology in stable transplant recipients. Moreover, indices were highly elevated in both patients with BOS. Spirometry and LCI showed poor correlation, indicating distinct and complementary physiologic measures.

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“…The pathophysiology of CLAD remains to be defined; however, the current paradigm is that CLAD results from recipient immune cells or antibodies injuring the allograft airway or alveolar compartments to cause loss of lung function. While new techniques to identify early CLAD with blood or bronchoalveolar lavage biomarkers or imaging, such as parametric response monitoring, 114 are in progress, much work remains to define pathogenesis and optimal treatments. Azithromycin 115,116 and perhaps montelukast 117 appear to be useful adjuncts to maintenance immunosuppression; however, augmenting immunosuppression often leads to infections and the role of steroids and other immunosuppressive agents in the treatment of CLAD is unclear.…”

Section: Complications Of Lung Transplantmentioning

confidence: 99%

Organ Transplantation for Cystic Fibrosis

Morrell

Kiel

Pilewski

2019

Semin Respir Crit Care Med

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Cystic fibrosis (CF) remains the most common indication for lung transplantation in children and the third most common in adults and has the highest median survival posttransplant for all pretransplant diagnoses. Criteria for transplant in patients with CF vary widely among transplant centers and early referral to multiple centers may be needed to maximize opportunities for lung transplantation. Comorbidities unique to CF such as resistant and atypical pathogens like Burkholderia and Mycobacterium abscessus, and cirrhosis require special consideration for lung transplantation but should not be considered as absolute contraindications. For those patients who are listed for lung transplantation, mechanical support with extracorporeal membrane oxygenation and mechanical ventilation can be efficacious as bridges to lung transplantation in experienced centers with adequate resources. Liver and pancreas transplantations are also acceptable options for end-organ disease related to CF and can provide improvements in both quantity and quality of life.

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Parametric Response Mapping as an Imaging Biomarker in Lung Transplant Recipients

Abstract: PRM is a novel imaging tool for lung transplant recipients presenting with spirometric decline. Quantifying underlying small airway obstruction via PRM helps further stratify the risk of death in patients with diverse spirometric decline patterns.

Cited by 59 publications

References 44 publications

Quantitative chest CT for subtyping chronic lung allograft dysfunction and its association with survival

Quantitative chest CT for subtyping chronic lung allograft dysfunction and its association with survival

Multiple breath washout in pediatric patients after lung transplantation

Organ Transplantation for Cystic Fibrosis

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