Lung Ultrasound to Phenotype Chronic Lung Allograft Dysfunction in Lung Transplant Recipients. A Prospective Observational Study

Journal of Clinical Medicine

Elisabeth Bendstrup¹  Martin Iversen²  Jørn Carlsen²  ThomasKromann Lund²  HansHenrik Lawaetz Schultz²  Michael Perch²  Mikkel Højlund³  DanielPilsgaard Henriksen³  Anna Kalhauge⁴  KlausNielsen Jeschke⁵  ChristianB. Laursen⁶  JesperRømhild Davidsen⁶ 

[1] Center for Rare Lung Diseases, Department Respiratory Diseases and Allergy, Aarhus University Hospital, 8200 Aarhus, Denmark;Department of Cardiology, Section for Lung Transplantation, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark;Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, 5000 Odense, Denmark;Department of Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark;Department of Respiratory Medicine, Copenhagen University Hospital, Hvidovre Hospital, 2650 Hvidovre, Denmark;South Danish Center for Interstitial Lung Diseases (SCILS), Odense University Hospital, 5000 Odense, Denmark;

关键词: bronchiolitis obliterans syndrome;    chronic lung allograft dysfunction;    lung transplantation;    lung ultrasound;    pleuroparenchymal fibroelastosis;    restrictive allograft syndrome;   

DOI  :  10.3390/jcm10051078

来源: DOAJ

【 摘 要 】

Background: Bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS) are two distinct phenotypes of chronic lung allograft dysfunction (CLAD) in lung transplant (LTx) recipients. Contrary to BOS, RAS can radiologically present with a pleuroparenchymal fibroelastosis (PPFE) pattern. This study investigates lung ultrasound (LUS) to identify potential surrogate markers of PPFE in order to distinguish CLAD phenotype RAS from BOS. Methods: A prospective cohort study performed at a National Lung Transplantation Center during June 2016 to December 2017. Patients were examined with LUS and high-resolution computed tomography of the thorax (HRCT). Results: Twenty-five CLAD patients (72% males, median age of 54 years) were included, corresponding to 19/6 BOS/RAS patients. LUS-identified pleural thickening was more pronounced in RAS vs. BOS patients (5.6 vs. 2.9 mm) compatible with PPFE on HRCT. LUS-identified pleural thickening as an indicator of PPFE in RAS patients’ upper lobes showed a sensitivity of 100% (95% CI; 54–100%), specificity of 100% (95% CI; 82–100%), PPV of 100% (95% CI; 54–100%), and NPV of 100% (95% CI; 82–100%). Conclusion: Apical pleural thickening detected by LUS and compatible with PPFE on HRCT separates RAS from BOS in patients with CLAD. We propose LUS as a supplementary tool for initial CLAD phenotyping.

【 授权许可】

Unknown