title: Early bronchiolitis obliterans syndrome shows an abnormality of perfusion not ventilation in lung transplant recipients.
abstract: Long-term survival of lung transplant patients is limited, principally because of Bronchiolitis Obliterans Syndrome (BOS). BOS is primarily classified based on airflow obstruction however there is recent data to suggest that the rejection process can lead to a restrictive ventilatory defect with involvement of the pulmonary vasculature. This study evaluates perfusion heterogeneity in different BOS stages by measuring the relative dispersion (RD) of an arterial spin labelling MRI blood flow image. Acinar ventilation heterogeneity (Sacin) was determined using the Multiple Breath Nitrogen Washout technique. In 24 post transplant patients with a range of severity in BOS status, Sacin increased as BOS level rose from stage 0 to stage 3. In contrast, RD-perfusion was not elevated at BOS 1 and 2 combined compared to BOS 0 and becoming elevated only at BOS-3. However, RD-perfusion in BOS-0p was elevated compared to BOS-0, without an increase in Sacin. These results suggest that BOS-0p is different in nature from other BOS stages.
authors.affiliation: Allergy Immunology and Respiratory Medicine, The Alfred Hospital and Department of Medicine Monash University, Melbourne, VIC, Australia. Electronic address: b.thompson@alfred.org.au.
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Thompson
authors.affiliation: Allergy Immunology and Respiratory Medicine, The Alfred Hospital and Department of Medicine Monash University, Melbourne, VIC, Australia.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Ellis
authors.affiliation: Allergy Immunology and Respiratory Medicine, The Alfred Hospital and Department of Medicine Monash University, Melbourne, VIC, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Stuart-Andrews
authors.affiliation: Departments of Medicine and Radiology University of California, La Jolla, San Diego, CA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Lopez
authors.affiliation: Departments of Medicine and Radiology University of California, La Jolla, San Diego, CA, USA.
authors.forename: Suraj
authors.initials: S
authors.lastname: Kedarisetty
authors.affiliation: Allergy Immunology and Respiratory Medicine, The Alfred Hospital and Department of Medicine Monash University, Melbourne, VIC, Australia.
authors.forename: Greg I
authors.initials: GI
authors.lastname: Snell
authors.affiliation: Departments of Medicine and Radiology University of California, La Jolla, San Diego, CA, USA.
authors.forename: G Kim
authors.initials: GK
authors.lastname: Prisk
mesh_terms: D001989:Bronchiolitis Obliterans / Q000175:diagnosis* / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D010477:Perfusion; D055420:Perfusion Imaging; D011183:Postoperative Complications / Q000175:diagnosis*; D013147:Spirometry; D066027:Transplant Recipients
chemical_list: D007166:Immunosuppressive Agents