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European Radiology

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Open Access 01-12-2011 | Chest

Thin-section Computed Tomography findings before and after azithromycin treatment of neutrophilic reversible lung allograft dysfunction

Authors: Pim A. de Jong, Robin Vos, Geert M. Verleden, Bart M. Vanaudenaerde, Johny A. Verschakelen

Published in: European Radiology | Issue 12/2011

Abstract

Objectives

Recently a novel subgroup of bronchiolitis obliterans syndrome (BOS) has been described in patients after lung transplantation with high neutrophil counts in broncho-alveolar lavage and recovery of lung functional decline with azithromycin treatment. We aimed to describe the thin-section computed tomography (CT) findings of these neutrophilic reversible allograft dysfunction (NRAD) patients before and after azithromycin.

Methods

A cohort of 100 lung transplant recipients with BOS were treated with azithromycin and underwent lung function testing, broncho-alveolar lavage and CT before azithromycin treatment and during follow-up. The 200 CT data sets were scored for bronchial dilatation, mucus plugging, centrilobular abnormalities, airway wall thickening, consolidation, ground glass and end-expiratory air trapping.

Results

NRAD was characterized by more centrilobular abnormalities on CT (p = 0.03 for prevalence and p = 0.06 for severity) compared to non-responders. At follow-up NRAD patients showed improvement in all CT abnormalities including air trapping, but the degree of improvement in all CT abnormalities was significantly different between responders and non-responders (who showed progression of bronchus dilatation, consolidation and air trapping).

Conclusions

Within BOS patients those with NRAD differ from azithromycin non-responders by more centrilobular abnormalities on CT before azithromycin and improvement in bronchus dilatation, consolidation and air trapping during treatment.

Estenne M, Maurer JR, Boehler A, Egan JJ, Frost A, Hertz M, Mallory GB, Snell GI, Yousem S (2002) Bronchiolitis obliterans syndrome 2001: an update of the diagnostic criteria. J Heart Lung Transplant 21:297–310PubMedCrossRef

Bankier AA, Van Muylem A, Knoop C, Estenne M, Gevenois PA (2001) Bronchiolitis obliterans syndrome in heart-lung transplant recipients: diagnosis with expiratory CT. Radiology 218:533–539PubMed

Vanaudenaerde BM, Meyts I, Vos R, Geudens N, De Wever W, Verbeken EK, Van Raemdonck DE, Dupont LJ, Verleden GM (2008) A dichotomy in bronchiolitis obliterans syndrome after lung transplantation revealed by azithromycin therapy. Eur Respir J 32:832–843PubMedCrossRef

Gerhardt SG, McDyer JF, Girgis RE, Conte JV, Yang SC, Orens JB (2003) Maintenance azithromycin therapy for bronchiolitis obliterans syndrome: results of a pilot study. Am J Respir Crit Care Med 168:121–125PubMedCrossRef

Verleden GM, Dupont LJ (2004) Azithromycin therapy for patients with bronchiolitis obliterans syndrome after lung transplantation. Transplantation 77:1465–1467PubMedCrossRef

Yates B, Murphy DM, Forrest IA, Ward C, Rutherford RM, Fisher AJ, Lordan JL, Dark JH, Corris PA (2005) Azithromycin reverses airflow obstruction in established bronchiolitis obliterans syndrome. Am J Respir Crit Care Med 172:772–775PubMedCrossRef

Shitrit D, Bendayan D, Gidon S, Saute M, Bakal I, Kramer MR (2005) Long-term azithromycin use for treatment of bronchiolitis obliterans syndrome in lung transplant recipients. J Heart Lung Transplant 24:1440–1443PubMedCrossRef

Gottlieb J, Szangolies J, Koehnlein T, Golpon H, Simon A, Welte T (2008) Long-term azithromycin for bronchiolitis obliterans syndrome after lung transplantation. Transplantation 85:36–41PubMedCrossRef

Vos R, Vanaudenaerde BM, Ottevaere A, Verleden SE, De Vleeschauwer SI, Willems-Widyastuti A, Wauters S, Van Raemdonck DE, Nawrot TS, Dupont LJ, Verleden GM (2010) Long-term azithromycin therapy for bronchiolitis obliterans syndrome: divide and conquer? J Heart Lung Transplant 29:1358–68PubMedCrossRef

10.

Verleden GM, Dupont LJ, Vanhaecke J, Daenen W, Van Raemdonck DE (2005) Effect of azithromycin on bronchiectasis and pulmonary function in a heart-lung transplant patient with severe chronic allograft dysfunction: a case report. J Heart Lung Transplant 24:1155–1158PubMedCrossRef

11.

de Jong PA, Dodd JD, Coxson HO, Storness-Bliss C, Paré PD, Mayo JR, Levy RD (2006) Bronchiolitis obliterans following lung transplantation: early detection using computed tomographic scanning. Thorax 61:799–804PubMedCrossRef

12.

Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J (2008) Fleischner Society: glossary of terms for thoracic imaging. Radiology 246:697–722PubMedCrossRef

13.

Matsuoka S, Uchiyama K, Shima H, Ueno N, Oish S, Nojiri Y (2003) Bronchoarterial ratio and bronchial wall thickness on high-resolution CT in asymptomatic subjects: correlation with age and smoking. AJR Am J Roentgenol 180:513–518PubMed

14.

American Thoracic Society (1995) Standardization of spirometry, 1994 update. Am J Respir Crit Care Med 152:1107–1136

15.

Dodd JD, de Jong PA, Levy RD, Coxson HO, Mayo JR (2008) Conventional high-resolution CT versus contiguous multidetector CT in the detection of bronchiolitis obliterans syndrome in lung transplant recipients. J Thorac Imaging 23:235–243PubMedCrossRef

16.

Leung AN, Fisher K, Valentine V, Girgis RE, Berry GJ, Robbins RC, Theodore J (1998) Bronchiolitis obliterans after lung transplantation: detection using expiratory HRCT. Chest 113:365–370PubMedCrossRef

17.

Siegel MJ, Bhalla S, Gutierrez FR, Hildebolt C, Sweet S (2001) Post-lung transplantation bronchiolitis obliterans syndrome: usefulness of expiratory thin-section CT for diagnosis. Radiology 220:455–462PubMed

18.

Lee ES, Gotway MB, Reddy GP, Golden JA, Keith FM, Webb WR (2000) Early bronchiolitis obliterans following lung transplantation: accuracy of expiratory thin-section CT for diagnosis. Radiology 216:472–477PubMed

19.

Konen E, Gutierrez C, Chaparro C, Murray CP, Chung T, Crossin J, Hutcheon MA, Paul NS, Weisbrod GL (2004) Bronchiolitis obliterans syndrome in lung transplant recipients: can thin-section CT findings predict disease before its clinical appearance? Radiology 231:467–473PubMedCrossRef

20.

Berstad AE, Aaløkken TM, Kolbenstvedt A, Bjørtuft O (2006) Performance of long-term CT monitoring in diagnosing bronchiolitis obliterans after lung transplantation. Eur J Radiol 58:124–131PubMedCrossRef

21.

Knollmann FD, Kapell S, Lehmkuhl H, Schulz B, Böttcher H, Hetzer R, Felix R (2004) Dynamic high-resolution electron-beam CT scanning for the diagnosis of bronchiolitis obliterans syndrome after lung transplantation. Chest 126:447–456PubMedCrossRef

22.

Choi YW, Rossi SE, Palmer SM, DeLong D, Erasmus JJ, McAdams HP (2003) Bronchiolitis obliterans syndrome in lung transplant recipients: correlation of computed tomography findings with bronchiolitis obliterans syndrome stage. J Thorac Imaging 18:72–79PubMedCrossRef

23.

Miller WT Jr, Kotloff RM, Blumenthal NP, Aronchick JM, Gefter WB, Miller WT (2001) Utility of high resolution computed tomography in predicting bronchiolitis obliterans syndrome following lung transplantation: preliminary findings. J Thorac Imaging 16:76–80PubMedCrossRef

24.

Knollmann FD, Ewert R, Wündrich T, Hetzer R, Felix R (2002) Bronchiolitis obliterans syndrome in lung transplant recipients: use of spirometrically gated CT. Radiology 225:655–662PubMedCrossRef

25.

Friedlander AL, Albert RK (2010) Chronic macrolide therapy in inflammatory airways diseases. Chest 138:1202–1212PubMedCrossRef

26.

Verleden GM, Vos R, De Vleeschauwer SI, Willems-Widyastuti A, Verleden SE, Dupont LJ, Van Raemdonck DE, Vanaudenaerde BM (2009) Obliterative bronchiolitis following lung transplantation: from old to new concepts? Transpl Int 22:771–779PubMedCrossRef

27.

Kim JS, Tanaka N, Newell JD, Degroote MA, Fulton K, Huitt G, Lynch DA (2005) Nontuberculous mycobacterial infection: CT scan findings, genotype, and treatment responsiveness. Chest 128:3863–3869PubMedCrossRef

28.

Gaillard EA, Carty H, Heaf D, Smyth RL (2003) Reversible bronchial dilatation in children: comparison of serial high-resolution computer tomography scans of the lungs. Eur J Radiol 47:215–20PubMedCrossRef

Title: Thin-section Computed Tomography findings before and after azithromycin treatment of neutrophilic reversible lung allograft dysfunction
Authors: Pim A. de Jong
Robin Vos
Geert M. Verleden
Bart M. Vanaudenaerde
Johny A. Verschakelen
Publication date: 01-12-2011
Publisher: Springer-Verlag
Published in: European Radiology / Issue 12/2011
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-011-2224-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Thin-section Computed Tomography findings before and after azithromycin treatment of neutrophilic reversible lung allograft dysfunction

Abstract

Objectives

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

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