Percentage of low attenuation area on computed tomography detects chronic lung allograft dysfunction, especially bronchiolitis obliterans syndrome, after bilateral lung transplantation

Kubo, Yujiro; Sugimoto, Seiichiro; Shiotani, Toshio; Matsubara, K; Hashimoto, Kohei; Tanaka, Shin; Shien, Kazuhiko; Suzawa, Ken; Miyoshi, Kenta; Yamamoto, Hiromasa; Okazaki, Mikio; Toyooka, Shinichi

doi:10.1111/ctr.15077

Cited by 2 publications

(1 citation statement)

References 27 publications

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“…The consolidations and pleural effusions were risk factors for death on follow-up CT scan [8]. Kubo et al [9] found that the percentage of low attenuation areas on expiratory CT scan can detect CLAD and especially BOS early. CT screening of the donor organ and identifying pulmonary abnormalities in the graft even before the lung transplant was performed, resulted in identifying patterns via machine learning that were indicative of a 19 times increased risk of CLAD development [10].…”

Section: Diagnosis Of Chronic Lung Allograft Dysfunctionmentioning

confidence: 99%

The diagnosis and management of chronic lung allograft dysfunction

Verleden,

Hendriks,

Verleden

2024

Current Opinion in Pulmonary Medicine

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Purpose of review Chronic lung allograft dysfunction (CLAD) remains a life-threatening complication following lung transplantation. Different CLAD phenotypes have recently been defined, based on the combination of pulmonary function testing and chest computed tomography (CT) scanning and spurred renewed interests in differential diagnosis, risk factors and management of CLAD. Recent findings Given their crucial importance in the differential diagnosis, we will discuss the latest development in assessing the pulmonary function and chest CT scan, but also their limitations in proper CLAD phenotyping, especially with regards to patients with baseline allograft dysfunction. Since no definitive treatment exists, it remains important to timely identify clinical risk factors, but also to assess the presence of specific patterns or biomarkers in tissue or in broncho alveolar lavage in relation to CLAD (phenotypes). We will provide a comprehensive overview of the latest advances in risk factors and biomarker research in CLAD. Lastly, we will also review novel preventive and curative treatment strategies for CLAD. Summary Although this knowledge has significantly advanced the field of lung transplantation, more research is warranted because CLAD remains a life-threatening complication for all lung transplant recipients.

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Section: Diagnosis Of Chronic Lung Allograft Dysfunctionmentioning

confidence: 99%

The diagnosis and management of chronic lung allograft dysfunction

Verleden,

Hendriks,

Verleden

2024

Current Opinion in Pulmonary Medicine

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Bronchiolitis Obliterans With Recurrent Pneumothorax After Allogeneic Bone Marrow Transplantation

Akatsuka,

Yama

2023

Cureus

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Bronchiolitis obliterans syndrome (BOS) is a non-infectious pulmonary complication that can occur in patients who have undergone allogeneic bone marrow transplantation (BMT). BOS is characterized by the irreversible narrowing and obstruction of bronchi, resulting in severe respiratory distress and poor outcomes. This case report focuses on the complex management of a patient with a multifaceted medical history. A 20-year-old man was initially diagnosed with precursor B lymphoblastic lymphoma and subsequently underwent allogeneic BMT. Nine months later, the patient was diagnosed with bronchiolitis obliterans with graft-versus-host disease, resulting in the development of BOS. Remarkably, 12 years after BMT, the patient was registered for lung transplantation. However, one year after registration, the patient developed a left pneumothorax. Despite rigorous efforts, including continuous thoracic drainage and autologous pleurodesis, the pneumothorax did not respond to treatment and required video-assisted thoracic surgery (VATS) bullectomy. The preoperative assessment revealed a challenging clinical finding characterized by the need for home oxygen therapy (5 L/min with a nasal cannula), severe Hugh-Jones classification IV-V, and marked hypercapnia (partial pressure of carbon dioxide (pCO 2 ), 76 mmHg). Imaging studies, including high-resolution computed tomography and chest radiography, revealed hyperinflation, emphysematous changes, and bronchiectasis across all lung lobes, further complicating the patient's condition. Intraoperative management had the unique challenges of persistent hypoxia (P/F ratio 65-80), positive end-expiratory pressure of 5 cmH 2 O, and low tidal volumes (1.6-2.0 mL/kg) during one-lung ventilation. To address these problems, both-lung ventilation had to be performed intermittently. However, hyperventilation remained unmanageable, with maximum pCO2 values reaching 140 mmHg. Following surgery, the patient had to be admitted to the intensive care unit in an intubated state. Fortunately, the following day, the patient's condition improved markedly, his state of consciousness was clear (Glasgow Coma Scale 15) and his pCO 2 level improved (66 mmHg) with spontaneous breath. This course of events allowed extubation and the patient was discharged to the general ward only two days after surgery. This case highlights the critical importance of a comprehensive preoperative assessment, including advanced imaging, when managing patients with BOS and complex pulmonary complications. Furthermore, it highlights the complexity and difficulty of perioperative respiratory management in such cases.

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Percentage of low attenuation area on computed tomography detects chronic lung allograft dysfunction, especially bronchiolitis obliterans syndrome, after bilateral lung transplantation

Cited by 2 publications

References 27 publications

The diagnosis and management of chronic lung allograft dysfunction

The diagnosis and management of chronic lung allograft dysfunction

Bronchiolitis Obliterans With Recurrent Pneumothorax After Allogeneic Bone Marrow Transplantation

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