Department of Medicine, University of Alberta, Edmonton, AB, Canada.
Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada.
Clin Transplant. 2021 Jul;35(7):e14315. doi: 10.1111/ctr.14315. Epub 2021 Apr 25.
Primary graft dysfunction (PGD) is an important contributor to early mortality in lung transplant recipients and is associated with impaired lung function. The radiographic sequelae of PGD on computed tomography (CT) have not been characterized.
We studied adult double lung transplant recipients from 2010 to 2016 for whom protocol 3-month post-transplant CT scans were available. We assessed CTs for changes including pleural effusions, ground glass opacification, atelectasis, centrilobular nodularity, consolidation, interlobular septal thickening, air trapping and fibrosis, and their relationship to prior post-transplant PGD, future lung function, post-transplant baseline lung allograft dysfunction (BLAD), and chronic lung allograft dysfunction (CLAD).
Of 237 patients studied, 50 (21%) developed grade 3 PGD (PGD3) at 48 or 72 h. PGD3 was associated with increased interlobular septal thickening (p = .0389) and atelectasis (p = .0001) at 3 months, but only atelectasis remained associated after correction for multiple testing. Atelectasis severity was associated with lower peak forced expiratory volume in 1 s (FEV1) and increased risk of BLAD (p = .0014) but not with future CLAD onset (p = .7789).
Severe PGD was associated with atelectasis on 3-month post-transplant CT in our cohort. Atelectasis on routine CT may be an intermediary identifiable stage between PGD and future poor lung function.
原发性移植物功能障碍（PGD）是肺移植受者早期死亡的重要原因，并与肺功能受损有关。PGD 在计算机断层扫描（CT）上的放射学后遗症尚未得到描述。
我们研究了 2010 年至 2016 年期间接受双肺移植的成年患者，这些患者均有协议规定的移植后 3 个月 CT 扫描。我们评估了 CT 上的变化，包括胸腔积液、磨玻璃影、肺不张、小叶中心结节、实变、小叶间隔增厚、空气潴留和纤维化，以及它们与移植后早期 PGD、未来肺功能、移植后基础肺移植物功能障碍（BLAD）和慢性肺移植物功能障碍（CLAD）的关系。
在 237 名研究患者中，50 名（21%）在 48 或 72 小时时发生 3 级 PGD（PGD3）。PGD3 与 3 个月时的小叶间隔增厚（p=0.0389）和肺不张（p=0.0001）增加有关，但在进行多次测试校正后，只有肺不张仍然相关。肺不张严重程度与峰值用力呼气量（FEV1）降低（p=0.0014）和 BLAD 风险增加（p=0.0014）相关，但与未来 CLAD 发病无关（p=0.7789）。
在我们的队列中，严重的 PGD 与移植后 3 个月的 CT 上的肺不张有关。常规 CT 上的肺不张可能是 PGD 和未来肺功能不良之间可识别的中间阶段。
