Saito Masao, Chen-Yoshikawa Toyofumi F, Nakamoto Yuji, Kayawake Hidenao, Tokuno Junko, Ueda Satoshi, Yamagishi Hiroya, Gochi Fumiaki, Okabe Ryo, Takahagi Akihiro, Hamaji Masatsugu, Motoyama Hideki, Aoyama Akihiro, Date Hiroshi
Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Transplant Direct. 2018 Oct 12;4(11):e398. doi: 10.1097/TXD.0000000000000839. eCollection 2018 Nov.
Early diagnosis of unilateral chronic lung allograft dysfunction (CLAD) is difficult because the unaffected contralateral lung functions as a reservoir in bilateral living-donor lobar lung transplantation (LDLLT). We previously reported the usefulness of Xe ventilation scintigraphy for detection of unilateral change, but the supply of Xe has been stopped globally. The present study aimed to examine the usefulness of inspiratory and expiratory computed tomography (I/E CT) volumetry for detection of unilateral change in CLAD patients.
This was a retrospective single-center, observational study using prospectively collected data. A total of 58 patients who underwent bilateral LDLLT from August 2008 to February 2017 were analyzed. Respiratory function tests, I/E CT were prospectively conducted. ΔLung volume was defined as the value obtained by subtracting expiratory lung volume from inspiratory lung volume.
Fourteen (24%) cases were clinically diagnosed with CLAD, of which 10 (71%) were diagnosed as unilateral CLAD. ΔLung volume of bilateral lungs strongly correlated with forced vital capacity ( = 0.92, < 0.01) and forced expiratory volume in 1 second (r = 0.80, < 0.01). Regardless the phenotypes (bronchiolitis obliterans syndrome or restrictive allograft syndrome) of CLAD, Δlung volume onset/baseline significantly decreased compared with that in the non-CLAD group. Among the 10 unilateral CLAD patients, 3 with clinically suspected unilateral rejection yet did not show a 20% decline in forced expiratory volume in 1 second. In 2 of these, Δlung volume of unilateral lungs on the rejection side decreased by 20% or more.
Our findings suggest that I/E CT volumetry may be useful for assessment and early diagnosis of unilateral CLAD after bilateral LDLLT.
在双侧活体供肺叶移植（LDLLT）中，由于未受影响的对侧肺起到了储备作用，早期诊断单侧慢性肺移植功能障碍（CLAD）较为困难。我们之前报道了氙气通气闪烁扫描在检测单侧变化方面的有效性，但全球范围内氙气供应已停止。本研究旨在探讨吸气和呼气计算机断层扫描（I/E CT）容积测量法在检测CLAD患者单侧变化中的有效性。
这是一项回顾性单中心观察性研究，使用前瞻性收集的数据。分析了2008年8月至2017年2月期间接受双侧LDLLT的58例患者。前瞻性地进行了呼吸功能测试和I/E CT检查。肺容积变化（ΔLung volume）定义为吸气肺容积减去呼气肺容积所得的值。
14例（24%）患者临床诊断为CLAD，其中10例（71%）诊断为单侧CLAD。双侧肺的ΔLung volume与用力肺活量（r = 0.92，P < 0.01）和第1秒用力呼气量（r = 0.80，P < 0.01）密切相关。无论CLAD的表型（闭塞性细支气管炎综合征或限制性移植综合征）如何，与非CLAD组相比，CLAD组的Δlung volume起始值/基线值显著降低。在10例单侧CLAD患者中，3例临床怀疑单侧排斥但第1秒用力呼气量未下降20%。其中2例排斥侧单侧肺的Δlung volume下降了20%或更多。
我们的研究结果表明，I/E CT容积测量法可能有助于双侧LDLLT后单侧CLAD的评估和早期诊断。
