TY - JOUR
T1 - Lung Ultrasound to Phenotype Chronic Lung Allograft Dysfunction in Lung Transplant Recipients. A Prospective Observational Study
AU - Davidsen, Jesper Rømhild
AU - Laursen, Christian B
AU - Højlund, Mikkel
AU - Lund, Thomas Kromann
AU - Jeschke, Klaus Nielsen
AU - Iversen, Martin
AU - Kalhauge, Anna
AU - Bendstrup, Elisabeth
AU - Carlsen, Jørn
AU - Perch, Michael
AU - Henriksen, Daniel Pilsgaard
AU - Schultz, Hans Henrik Lawaetz
PY - 2021/3/5
Y1 - 2021/3/5
N2 - 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.
AB - 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.
KW - bronchiolitis obliterans syndrome
KW - chronic lung allograft dysfunction
KW - lung transplantation
KW - lung ultrasound
KW - pleuroparenchymal fibroelastosis
KW - restrictive allograft syndrome
KW - Bronchiolitis obliterans syndrome
KW - Restrictive allograft syndrome
KW - Pleuroparenchymal fibroelastosis
KW - Lung transplantation
KW - Chronic lung allograft dysfunction
KW - Lung ultrasound
UR - http://www.scopus.com/inward/record.url?scp=85114067310&partnerID=8YFLogxK
U2 - 10.3390/jcm10051078
DO - 10.3390/jcm10051078
M3 - Journal article
C2 - 33807615
VL - 10
SP - 1
EP - 14
JO - Journal of Clinical Medicine
JF - Journal of Clinical Medicine
SN - 2077-0383
IS - 5
M1 - 1078
ER -