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Open Access 01-12-2023 | Computed Tomography | Original Article

Early chest CT abnormalities to predict the subsequent occurrence of chronic lung allograft dysfunction

Authors: Paul Habert, Elsa Chetrit, Benjamin Coiffard, Fabienne Bregeon, Pascal Thomas, Anderson Loundou, Julien Bermudez, Martine Reynaud-Gaubert, Jean-Yves Gaubert

Published in: Insights into Imaging | Issue 1/2023

Abstract

Introduction

Chronic lung allograft dysfunction (CLAD) can take two forms: bronchiolitis obliterans syndrome (BOS) or restrictive allograft syndrome (RAS). The aim was to determine if chest-CT abnormalities after lung transplantation (LTx) could predict CLAD before respiratory functional deterioration.

Materials and methods

This monocentric retrospective study analyzed consecutive patients who underwent LTx from January 2015 to December 2018. Initial CT post-LTx (CTi) and a follow-up CT at least 9 months post-LTx (CTf) were reviewed. CLAD was defined as a persistent respiratory functional decline (> 20% of basal FEV₁) outside acute episode. A Cox regression was performed in univariate, then in multivariate analysis (including features with p < 0.01 in univariate or of clinical importance) to determine risk factors for CLAD. Subgroup analyses were made for BOS, RAS, and death.

Results

Among 118 LTx patients (median (min–max) 47 (18–68) years), 25 developed CLAD during follow-up (19 BOS). The median time to CLAD since LTx was 570 days [150–1770]. Moderate pulmonary artery stenosis (30–50%) was associated with the occurrence of CLAD on CTi (hazard ratio HR = 4.6, CI [1.6–13.2]) and consolidations and pleural effusion on CTf (HR = 2.6, CI [1.3–4.9] and HR = 4.5, CI [1.5–13.6] respectively). The presence of mosaic attenuation (HR = 4.1, CI [1.4–12.5]), consolidations (HR = 2.6, CI [1.3–5.4]), and pleural effusions (p = 0.01, HR = 5.7, CI [1.4–22.3]) were risk factors for BOS on CTf. The consolidations (p = 0.029) and pleural effusions (p = 0.001) were risk factors for death on CTf.

Conclusions

CTi and CTf in the monitoring of LTx patients could predict CLAD. Moderate pulmonary artery stenosis, mosaic pattern, parenchyma condensations, and pleural effusions were risk factors for CLAD.

Critical relevance statement

There is a potential predictive role of chest CT in the follow-up of LTx patients for chronic lung allograft dysfunction (CLAD). Early chest CT should focus on pulmonary artery stenosis (risk factor for CLAD in this study). During the follow-up (at least 9 months post-LTx), parenchymal consolidations and pleural effusions were shown to be risk factors for CLAD, and death in subgroup analyses.

Key points

• Pulmonary artery stenosis (30–50%) on initial chest-CT following lung transplantation predicts CLAD HR = 4.5; CI [1.6–13.2].

• Pleural effusion and consolidations 1 year after lung transplantation predict CLAD and death.

• Early evaluation of lung transplanted patients should evaluate pulmonary artery anastomosis.

Graphical Abstract

Available only for authorised users

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Title: Early chest CT abnormalities to predict the subsequent occurrence of chronic lung allograft dysfunction
Authors: Paul Habert
Elsa Chetrit
Benjamin Coiffard
Fabienne Bregeon
Pascal Thomas
Anderson Loundou
Julien Bermudez
Martine Reynaud-Gaubert
Jean-Yves Gaubert
Publication date: 01-12-2023
Publisher: Springer Vienna
Keywords: Computed Tomography
Computed Tomography
Pleural Effusion
Bronchiectasis
Published in: Insights into Imaging / Issue 1/2023
Electronic ISSN: 1869-4101
DOI: https://doi.org/10.1186/s13244-023-01509-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Early chest CT abnormalities to predict the subsequent occurrence of chronic lung allograft dysfunction

Abstract

Introduction

Materials and methods

Results

Conclusions

Critical relevance statement

Key points

Graphical Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

Critical relevance statement

Key points

Graphical Abstract

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