Prognostic Value of Chest CT Findings at BOS Diagnosis in Lung Transplant Recipients

Abstract

Background. Bronchiolitis obliterans syndrome (BOS) after lung transplantation is characterized by fibrotic small airway remodeling, recognizable on high-resolution computed tomography (HRCT). We studied the prognostic value of key HRCT features at BOS diagnosis after lung transplantation. Methods. The presence and severity of bronchiectasis, mucous plugging, peribronchial thickening, parenchymal anomalies, and air trapping, summarized in a total severity score, were assessed using a simplified Brody II scoring system on HRCT at BOS diagnosis, in a cohort of 106 bilateral lung transplant recipients transplanted between January 2004 and January 2016. Obtained scores were subsequently evaluated regarding post-BOS graft survival, spirometric parameters, and preceding airway infections. Results. A high total Brody II severity score at BOS diagnosis (P = 0.046) and high subscores for mucous plugging (P = 0.0018), peribronchial thickening (P = 0.0004), or parenchymal involvement (P = 0.0121) are related to worse graft survival. A high total Brody II score was associated with a shorter time to BOS onset (P = 0.0058), lower forced expiratory volume in 1 s (P = 0.0006) forced vital capacity (0.0418), more preceding airway infections (P = 0.004), specifically with Pseudomonas aeruginosa (P = 0.002), and increased airway inflammation (P = 0.032). Conclusions. HRCT findings at BOS diagnosis after lung transplantation provide additional information regarding its underlying pathophysiology and for future prognosis of graft survival.

The diagnosis and management of chronic lung allograft dysfunction

“…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]. Van Herck et al [11] demonstrated that the presence and severity of bronchiectasis, and high subscores for mucous plugging, peribronchial thickening or parenchymal involvement are related to worse graft survival. A high score was also associated with a shorter time to BOS onset, lower FEV 1 , forced vital capacity, more preceding airway infections, specifically with Pseudomonas aeruginosa, and increased airway inflammation [11].…”

“…Van Herck et al [11] demonstrated that the presence and severity of bronchiectasis, and high subscores for mucous plugging, peribronchial thickening or parenchymal involvement are related to worse graft survival. A high score was also associated with a shorter time to BOS onset, lower FEV 1 , forced vital capacity, more preceding airway infections, specifically with Pseudomonas aeruginosa, and increased airway inflammation [11]. In another study, a machine learning tool was used to quantify ground-glass opacity, reticulation, hyperlucent lung and pulmonary vessel volume (PVV) at CLAD diagnosis for phenotyping and prognostication compared with formal radiologist scoring.…”

Can We See Clearly Now? Computed Tomography for Bronchiolitis Obliterans Syndrome Prognostication

“…5,6 In this issue of Transplantation, Van Herck and colleagues offer a radiographic prognostication tool for BOS, which can used by pulmonologists at the bedside to provide timely counseling. 7 The group utilizes a simplified Brody II scoring system, which was originally conceived to objectify severity of pulmonary abnormalities on chest computed tomography (CT) for patients with cystic fibrosis. 8 The Brody II score aims to quantify aspects of lung airway pathology including severity and extent of (a) central and peripheral bronchiectasis; (b) central and peripheral mucus plugging; (c) central and peripheral peribronchial wall thickening; (d) parenchymal changes (such as ground glass opacification, consolidation, blebs/bullae); and (e) air-trapping on expiratory images.…”