Unilateral Chronic Lung Allograft Dysfunction Assessed by Biphasic Computed Tomographic Volumetry in Bilateral Living-donor Lobar Lung Transplantation
Unilateral Chronic Lung Allograft Dysfunction Assessed by Biphasic Computed Tomographic Volumetry in Bilateral Living-donor Lobar Lung Transplantation
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DOI：
10.1097/txd.0000000000000839
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发表时间：
2018-11-01
影响因子：
2.3
通讯作者：
Date, Hiroshi
中科院分区：
文献类型：
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作者：
Saito, Masao;Chen-Yoshikawa, Toyofumi F.;Date, Hiroshi
单侧慢性肺移植物功能障碍（CLAD）的早期诊断是困难的，因为在双侧活体供者肺叶肺移植（LDLLT）中，未受影响的对侧肺作为储库发挥功能。我们以前曾报道过使用133-氟替卡松通气造影检测单侧改变的有效性，但133-氟替卡松的供应已在全球范围内停止。本研究的目的是检查吸气和呼气的计算机断层扫描（I/E CT）容量测定法的有用性，用于检测CLAD patients.Methods的单侧变化，这是一个回顾性的单中心，观察性研究，使用前瞻性收集的数据。分析了2008年8月至2017年2月期间接受双侧LDLLT的共58例患者。前瞻性进行呼吸功能检查、I/E CT。结果14例（24%）临床诊断为CLAD，其中单侧CLAD 10例（71%）。双肺肺容积与用力肺活量（r = 0.92，P < 0.01）、1秒用力呼气量（r = 0.80，P < 0.01）呈显著正相关。无论CLAD的表型（闭塞性细支气管炎综合征或限制性同种异体移植综合征）如何，与非CLAD组相比，肺容量起始/基线显著降低。在10例单侧CLAD患者中，3例临床疑似单侧排斥反应，但1秒用力呼气量未下降20%。在其中2例中，排斥反应侧的单侧肺体积减少了20%或更多。结论我们的研究结果表明，I/E CT容积测量可能是有用的评估和早期诊断单侧CLAD后，双边LDLLT。
Background Early diagnosis of unilateral chronic lung allograft dysfunction (CLAD) is difficult because the unaffected contralateral lung functions as a reservoir in bilateral living-donor lobar lung transplantation (LDLLT). We previously reported the usefulness of Xe-133 ventilation scintigraphy for detection of unilateral change, but the supply of Xe-133 has been stopped globally. The present study aimed to examine the usefulness of inspiratory and expiratory computed tomography (I/E CT) volumetry for detection of unilateral change in CLAD patients.Methods This was a retrospective single-center, observational study using prospectively collected data. A total of 58 patients who underwent bilateral LDLLT from August 2008 to February 2017 were analyzed. Respiratory function tests, I/E CT were prospectively conducted. Lung volume was defined as the value obtained by subtracting expiratory lung volume from inspiratory lung volume.Results Fourteen (24%) cases were clinically diagnosed with CLAD, of which 10 (71%) were diagnosed as unilateral CLAD. Lung volume of bilateral lungs strongly correlated with forced vital capacity (r = 0.92, P < 0.01) and forced expiratory volume in 1 second (r = 0.80, P < 0.01). Regardless the phenotypes (bronchiolitis obliterans syndrome or restrictive allograft syndrome) of CLAD, lung volume onset/baseline significantly decreased compared with that in the non-CLAD group. Among the 10 unilateral CLAD patients, 3 with clinically suspected unilateral rejection yet did not show a 20% decline in forced expiratory volume in 1 second. In 2 of these, lung volume of unilateral lungs on the rejection side decreased by 20% or more.Conclusions Our findings suggest that I/E CT volumetry may be useful for assessment and early diagnosis of unilateral CLAD after bilateral LDLLT.