title: Phenotyping Chronic Lung Allograft Dysfunction Using Body Plethysmography and Computed Tomography.
abstract: Restrictive subtype of chronic lung allograft dysfunction (CLAD) was recently described after lung transplantation. This study compares different definitions of a restrictive phenotype in CLAD patients and impact on survival. Eighty-nine CLAD patients out of 1191 screened patients (September 1987 to July 2012) were included as complete longitudinal lung volume measurements and chest computed tomography (CT) after CLAD onset was available. CT findings and lung volumes were quantified and survival was calculated for distinctive groups and predictive factors for worse survival were investigated. Graft survival in patients with total lung capacity (TLC) between 90% and 81% of baseline (BL) (n = 13, 15%) in CLAD course was similar to those with TLC >90% BL (n = 64, 56%; log-rank test p = 0.9). Twelve patients (13%) developed a TLC ≤80% BL and 10 (11%) had significant parenchymal changes on CT, of whom 6 (46%) also had TLC ≤80% BL. CT changes correlated with TLC ≤80% BL (Φ-coefficient = 0.48, p = 0.001). Patients with either TLC ≤80% or significant CT changes (n = 16, 18%) had a significantly reduced survival (log-rank p < 0.001). Forced vital capacity loss at CLAD onset was associated with poorer survival but did not correlate with the TLC or CT changes. A restrictive subtype of CLAD may be defined by either TLC ≤80% BL or severe parenchymal changes on chest CT.
authors.affiliation: Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany. suhling.hendrik@mh-hannover.de.
authors.forename: H
authors.initials: H
authors.lastname: Suhling
authors.affiliation: Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Dettmer
authors.affiliation: Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Greer
authors.affiliation: Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Fuehner
authors.affiliation: Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Avsar
authors.affiliation: Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Haverich
authors.affiliation: Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Welte
authors.affiliation: Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Gottlieb
mesh_terms: D000328:Adult; D064591:Allografts; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D008171:Lung Diseases / Q000601:surgery*; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D010991:Plethysmography / Q000379:methods*; D055031:Primary Graft Dysfunction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: bronchiolitis obliterans (BOS); bronchoalveolar lavage (BAL); classification; clinical research/practice; fibrosis; immunosuppression/immune modulation; lung transplantation/pulmonology; rejection: chronic; systems