Increased lung clearance of 99mTcDTPA in allograft lung rejection. The Paris-Sud Lung Transplant Group.
To investigate whether lung 99mTc-DTPA clearance is altered during allograft lung rejection, a group of four double lung and 24 heart-lung transplant patients was studied using serial measurement of the clearance rate of aerosolized 99mTc-DTPA (DTPA-Cl), in association with pulmonary function tests, bronchoalveolar lavage, and transbronchial lung biopsies. Using histologic diagnosis as a standard, we compared 56 episodes with normal lung histology to 32 episodes with allograft lung rejection. A control group of 20 healthy nonsmokers was used to define normal DTPA-Cl. In patients with normal lung histology, DTPA-Cl was higher than in control subjects (2.62 +/- 0.25 versus 1.20 +/- 0.12 %/min; p less than 0.001). In the episodes of allograft lung rejection, DTPA-Cl increased to 3.65 +/- 0.41 %/min (p less than 0.02) as compared with episodes of normal lung histology. The change in DTPA-Cl during allograft lung rejection was correlated (r = 0.3, p less than 0.01) with the increased percentage of lymphocytes in bronchoalveolar lavage (27.8 +/- 3.5% in rejection versus 19.9 +/- 2.2% in normal histology; p less than 0.02). Sensitivity and specificity of DTPA-Cl measurement in detecting lung rejection were 69 and 82%, respectively, versus 45 and 85% for FEV1 measurement. These results suggest that DTPA-Cl monitoring could be used in conjunction with pulmonary function testing as a noninvasive approach for the detection of lung rejection.
Herve
P A
PA
Service de Chirugie Thoracique et de Médecine Nuclélaire, Hopital Marie-Lannelongue et Service de Pneumologie, Hopital Antoine Béclère, Université Paris-Sud, France.
Silbert
D
D
Mensch
J
J
Cerrina
J
J
Ladurie
F L
FL
Rain
B
B
Bavoux
E
E
Chapelier
A
A
Dartevelle
P
P
Lafont
D
D
D000328:Adult; D001706:Biopsy; D001992:Bronchoalveolar Lavage Fluid; D005260:Female; D006084:Graft Rejection / Q000276:immunology*; D016041:Heart-Lung Transplantation / Q000000981:diagnostic imaging; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D016040:Lung Transplantation / Q000000981:diagnostic imaging* / Q000276:immunology; D008297:Male; D011877:Radionuclide Imaging; D012129:Respiratory Function Tests; D012680:Sensitivity and Specificity; D016284:Technetium Tc 99m Pentetate
D016284:Technetium Tc 99m Pentetate