Early chest CT abnormalities to predict the subsequent occurrence of chronic lung allograft dysfunction

被引：2

作者：

Habert, Paul ^{[1
,2
,3
]}

Chetrit, Elsa ^{[1
]}

Coiffard, Benjamin ^{[4
]}

Bregeon, Fabienne ^{[5
,6
]}

Thomas, Pascal ^{[7
]}

Loundou, Anderson ^{[8
,9
]}

Bermudez, Julien ^{[4
]}

Reynaud-Gaubert, Martine ^{[4
]}

Gaubert, Jean-Yves ^{[2
,3
,10
]}

机构：

[1] Hop Nord Marseille, Serv Radiol, F-13015 Marseille, France

[2] Aix Marseille Univ, LIIE, Marseille, France

[3] Aix Marseille Univ, CERIMED, Marseille, France

[4] Hop Nord Marseille, Ctr Ressources & Competences Mucoviscidose CRCM Ad, AP HM, F-13015 Marseille, France

[5] Hop Nord Marseille, APHM, Explorat Fonct Resp, Marseille, France

[6] Aix Marseille Univ, APHM, Microbes Evolut Phylogeny & Infect MEPHI, IHU Mediterranee Infect, Marseille, France

[7] Hop Nord Marseille, Serv Chirurg Thorac, F-13015 Marseille, France

[8] Aix Marseille Univ, Hlth Serv Res & Qual Life Ctr, CEReSS, UR3279, Marseille, France

[9] AP HM, Dept Publ Hlth, Marseille, France

[10] La Timone Hop, Serv Radiol, 264 Rue St Pierre, F-13005 Marseille, France

来源：

INSIGHTS INTO IMAGING | 2023年 / 14卷 / 01期

关键词：

Lung transplantation; Follow-up studies; Graft rejection; X-Ray computed tomography; BRONCHIOLITIS OBLITERANS SYNDROME; THIN-SECTION CT; INTERNATIONAL-SOCIETY; TRANSPLANT RECIPIENTS; HEART-LUNG; CLASSIFICATION; DIAGNOSIS; RISK; REJECTION; REGISTRY;

D O I：

10.1186/s13244-023-01509-3

中图分类号：

R8 [特种医学]; R445 [影像诊断学];

学科分类号：

1002 ; 100207 ; 1009 ;

摘要：

Introduction Chronic lung allograft dysfunction (CLAD) can take two forms: bronchiolitis obliterans syndrome (BOS) or restrictive allograft syndrome (RAS). The aim was to determine if chest-CT abnormalities after lung transplantation (LTx) could predict CLAD before respiratory functional deterioration.Materials and methods This monocentric retrospective study analyzed consecutive patients who underwent LTx from January 2015 to December 2018. Initial CT post-LTx (CTi) and a follow-up CT at least 9 months post-LTx (CTf) were reviewed. CLAD was defined as a persistent respiratory functional decline (> 20% of basal FEV1) outside acute episode. A Cox regression was performed in univariate, then in multivariate analysis (including features with p < 0.01 in univariate or of clinical importance) to determine risk factors for CLAD. Subgroup analyses were made for BOS, RAS, and death.Results Among 118 LTx patients (median (min-max) 47 (18-68) years), 25 developed CLAD during follow-up (19 BOS). The median time to CLAD since LTx was 570 days [150-1770]. Moderate pulmonary artery stenosis (30-50%) was associated with the occurrence of CLAD on CTi (hazard ratio HR = 4.6, CI [1.6-13.2]) and consolidations and pleural effusion on CTf (HR = 2.6, CI [1.3-4.9] and HR = 4.5, CI [1.5-13.6] respectively). The presence of mosaic attenuation (HR = 4.1, CI [1.4-12.5]), consolidations (HR = 2.6, CI [1.3-5.4]), and pleural effusions (p = 0.01, HR = 5.7, CI [1.4-22.3]) were risk factors for BOS on CTf. The consolidations (p = 0.029) and pleural effusions (p = 0.001) were risk factors for death on CTf.Conclusions CTi and CTf in the monitoring of LTx patients could predict CLAD. Moderate pulmonary artery stenosis, mosaic pattern, parenchyma condensations, and pleural effusions were risk factors for CLAD.Critical relevance statement There is a potential predictive role of chest CT in the follow-up of LTx patients for chronic lung allograft dysfunction (CLAD). Early chest CT should focus on pulmonary artery stenosis (risk factor for CLAD in this study). During the follow-up (at least 9 months post-LTx), parenchymal consolidations and pleural effusions were shown to be risk factors for CLAD, and death in subgroup analyses.

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页数：9