Functional and computed tomographic evolution and survival of restrictive allograft syndrome after lung transplantation
Section snippets
Patients’ characteristics
Patients who underwent double-lung or heart–lung transplantation between 2001 and 2012 were retrospectively recruited. All patients provided written informed consent before transplantation. CLAD was defined as a persistent FEV1 decline of ≥ 20% compared with the mean of the two best post-operative values. Subsequently, irreversible CLAD was defined as a lack of improvement in FEV1 after azithromycin therapy. Within the CLAD patient group, RAS was diagnosed in cases of restrictive pulmonary
Patients’ characteristics
Detailed characteristics of patients are presented in Table 1. Twenty-four of the patients were ultimately diagnosed with RAS. At the end of the study period, 5 patients were alive and did not undergo retransplantation, 10 underwent retransplantation, and 9 died. Mean time of developing CLAD after transplantation was 1,194 ± 206 days. Mean time of follow-up after diagnosis of CLAD was 584 ± 111 days (182 to 3,521 days). Fifty percent graft loss after CLAD diagnosis occurred at 501 days. At
Discussion
In 24 patients who ultimately fulfilled the RAS criteria, we evaluated changes in CT patterns from pre-CLAD to end-stage CLAD in relation to pulmonary function and survival. The most prominent features at diagnosis of CLAD compared with the last pre-CLAD CT were appearance of central and peripheral ground glass and septal and non-septal lines. Survival after diagnosis of CLAD was only associated with FVC at the moment of CLAD diagnosis, but not with any CT alterations. When comparing the
Disclosure statement
The authors have no conflicts of interest to disclose.
G.M.V. is holder of the GSK chair in respiratory pharmacology at the KU Leuven and is supported by the Research Foundation Flanders (FWO) (G.0723.10, G.0705.12 and G.0679.12) and Onderzoeksfonds KU Leuven (OT/10/050). B.M.V. and D.E.v.R. are senior research fellows of the FWO. S.E.V. is supported by the KU Leuven Research Fund. RV is partially funded by Klinisch Onderzoeksfonds UZ Leuven.
References (13)
- et al.
The registry of the International Society for Heart and Lung Transplantation: 29th adult lung and heart–lung transplant report–2012
J Heart Lung Transplant
(2012) - et al.
Bronchiolitis obliterans syndrome 2001: an update of the diagnostic criteria
J Heart Lung Transplant
(2002) - et al.
Restrictive allograft syndrome (RAS): a novel form of chronic lung allograft dysfunction
J Heart Lung Transplant
(2011) - et al.
Restrictive allograft syndrome post lung transplantation is characterized by pleuroparenchymal fibroelastosis
Mod Pathol
(2013) - et al.
Upper lobe fibrosis: a novel manifestation of chronic allograft dysfunction in lung transplantation
J Heart Lung Transplant
(2005) - et al.
Pirfenidone in patients with idiopathic pulmonary fibrosis (CAPACITY): two randomised trials
Lancet
(2011)
Cited by (54)
Quantitative Multivolume Proton-Magnetic Resonance Imaging in Lung Transplant Recipients: Comparison With Computed Tomography and Spirometry
2021, Academic RadiologyCitation Excerpt :In the acute setting, it can be nonspecific, needing additional tests as support (2,3), while in the evaluation of chronic lung allograft dysfunction (CLAD), CT imaging may show fibrosis and ground glass opacities (4,5), air trapping (AT) on expiratory imaging (6), mosaic attenuation (7), bronchial wall thickening, and bronchiectasis (8,9). CT scoring systems have been formulated to help clinicians in CLAD diagnosis and classification (4,9). Recently, quantitative CT, which quantifies pulmonary ventilation as expiratory-inspiratory density variation (10,11) has been proposed for early detection and monitoring of CLAD (12,13).
Noninvasive methods for detection of chronic lung allograft dysfunction in lung transplantation
2020, Transplantation ReviewsLung Transplant Pathology: An Overview on Current Entities and Procedures
2020, Surgical Pathology ClinicsUse of CT-SCAN score and volume measures to early identify restrictive allograft syndrome in single lung transplant recipients
2020, Journal of Heart and Lung TransplantationCitation Excerpt :Lung opacity changes over time were more pronounced in upper and middle areas of the graft lung, similar to the initial RAS series.1,2,22 We tested a previously described CT-score11 based on reticular and consolidation changes, which are frequently reported early during RAS1,20,23 and found to be associated to a functional restrictive pattern and graft survival in double-LTx patients with RAS.11 A striking finding was that the date of T-onset in patients with RAS with a CT - score ≥2 occurred in advance of the date of CLAD in half of patients of this group, as compared with no patient in the BOS group.
Chronic lung allograft dysfunction: Definition and update of restrictive allograft syndrome―A consensus report from the Pulmonary Council of the ISHLT
2019, Journal of Heart and Lung TransplantationPrognostic significance of early pulmonary function changes after onset of chronic lung allograft dysfunction
2019, Journal of Heart and Lung Transplantation