Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy.
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
Sci Rep. 2020 Dec 18;10(1):22316. doi: 10.1038/s41598-020-79442-4.
Despite the promising results achieved so far in long-term survival after lung transplantation (LuTx), airway complications (ACs) still arise in the post-operative period. Early diagnosis and prompt treatment of ACs play a critical role in preventing their onset. Specifically, large bronchi ischemia has been recognized as a triggering factor for ACs. Autofluorescence bronchoscopy, which was first introduced for early cancer diagnosis, displays ischemic mucosae as red spots, while normal vascularized mucosae appear in green. The aim of this study is to investigate whether a significant correlation exists between ACs and the red/green (RG) ratio detected on scheduled autofluorescence bronchoscopy up to 1 year after LuTx. This prospective, observational, single-center cohort study initially considered patients who underwent LuTx between July 2014 and February 2016. All patients underwent concomitant white-light and autofluorescence bronchoscopy at baseline (immediately after LuTx), on POD7, POD14, POD21, POD28, POD45, 3 months, 6 months, and 1 year after LuTx. An autofluorescence image of the first bronchial carina distal to the anastomosis was captured and analyzed using histograms for red and green pixels; the R/G ratio was then recorded. Potential ACs were classified according according to the presence of a white-light following the MDS (macroscopic aspect, diameter and suture) criteria. The authors assessed the association between the R/G ratio and the ACs occurrence using a generalized estimating equations model. Thirty-one patients met the inclusion criteria and were therefore selected. Out of a total of 53 bronchial anastomoses, 8 developed complications (late bronchial stenosis), with an average onset time of 201 days after LuTx. ACs showed a similar baseline covariate value when compared to anastomoses that involved no complication. Generalized estimating equations regression indicated a clear association over time between the R/G ratio and the rise of complications (p = 0.023). The authors observed a significant correlation between post-anastomotic stenosis and the delayed decrease of the R/G ratio. Preliminary outcomes suggest that autofluorescence bronchoscopy may be an effective and manageable diagnostic tool, proving complementary to other instruments for early diagnosis of ACs after LuTx. Further research is needed to confirm and detail preliminary findings.
尽管肺移植（LuTx）后长期生存取得了有希望的结果，但气道并发症（ACs）仍在术后发生。早期诊断和及时治疗 ACs 对预防其发生至关重要。具体而言，大支气管缺血已被认为是 ACs 的触发因素。自体荧光支气管镜检查最初用于早期癌症诊断，显示缺血性黏膜呈红色斑点，而正常血管化黏膜呈绿色。本研究旨在探讨 LuTx 后 1 年内定期自体荧光支气管镜检查中检测到的 ACs 与红/绿（RG）比值之间是否存在显著相关性。这项前瞻性、观察性、单中心队列研究最初考虑了 2014 年 7 月至 2016 年 2 月期间接受 LuTx 的患者。所有患者均在基线（LuTx 后立即）、术后第 7 天（POD7）、第 14 天（POD14）、第 21 天（POD21）、第 28 天（POD28）、第 45 天（POD45）、3 个月、6 个月和 1 年后进行了白光和自体荧光支气管镜检查。捕获并分析了第一个支气管隆突远端的自体荧光图像，用于红色和绿色像素的直方图；然后记录 R/G 比值。根据 MDS（宏观方面、直径和缝合）标准后出现的白光，将潜在的 ACs 进行分类。作者使用广义估计方程模型评估了 R/G 比值与 ACs 发生之间的关联。31 名患者符合纳入标准，因此被选中。在总共 53 个支气管吻合术中，有 8 个出现并发症（晚期支气管狭窄），平均在 LuTx 后 201 天发病。与无并发症的吻合口相比，ACs 的基线协变量值相似。广义估计方程回归表明，R/G 比值与并发症的发生之间存在明显的时间相关性（p=0.023）。作者观察到吻合口后狭窄与 R/G 比值延迟下降之间存在显著相关性。初步结果表明，自体荧光支气管镜检查可能是一种有效且易于管理的诊断工具，对 LuTx 后 ACs 的早期诊断具有补充作用。需要进一步研究来证实和详细描述初步发现。
