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

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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.

Original languageEnglish
Article number1078
JournalJournal of Clinical Medicine
Issue number5
Pages (from-to)1-14
Number of pages14
Publication statusPublished - 5 Mar 2021

    Research areas

  • bronchiolitis obliterans syndrome, chronic lung allograft dysfunction, lung transplantation, lung ultrasound, pleuroparenchymal fibroelastosis, restrictive allograft syndrome, Bronchiolitis obliterans syndrome, Restrictive allograft syndrome, Pleuroparenchymal fibroelastosis, Lung transplantation, Chronic lung allograft dysfunction, Lung ultrasound

ID: 64730996