Division of Pediatric Respiratory Medicine, Stollery Children Hospital, University of Alberta, Edmonton, Canada.
Division of Occupational and Environmental Medicine, Epidemiology, Biostatistics, and Prevention Institute, University of Zurich & University Hospital Zurich, Zurich, Switzerland.
Pediatr Pulmonol. 2023 Jan;58(1):213-221. doi: 10.1002/ppul.26187. Epub 2022 Oct 14.
Chronic lung allograft dysfunction (CLAD) continues to negatively impact the survival of pediatric lung transplant (LTx) recipients. Current consensus guidelines are adult-focused. We sought to examine CLAD detection and monitoring practices at pediatric LTx programs.
We conducted a survey among the International Pediatric Lung Transplant Collaborative. Questions consisted of practitioner's experience, LTx program demographics, and querying tests used for CLAD surveillance and detection. Investigations queried included: chest x-ray (CXR), chest computed tomography (CT), lung magnetic resonance imaging (MRI), ventilation/perfusion scanning, conventional pulmonary function testing (PFT), multiple breath washout (MBW), infant/preschool PFT, bronchoalveolar lavage, transbronchial biopsies (TBBx), or other tissue sampling techniques. Preferences for certain modalities over others were questioned based on a five-point Likert scale.
Twenty-four of 25 programs responded. Chest CT and CXR are used generally for both CLAD surveillance and detection. No programs use lung MRI clinically, it may have some utility in the future. While all centers use conventional PFT, MBW, and infant/preschool PFT are used in one-fifth and one-third of centers, respectively. While the majority of programs use TBBx, only 41.7% would obtain a diagnosis based on tissue histopathology over noninvasive techniques if CLAD is suspected. Utilization of biomarkers is still limited.
Our results indicate continued use of conventional PFT along with chest CT and less so CXR for CLAD detection and monitoring in the large majority of centers. Infant/preschool PFT and novel methods such as MBW are used in a few centers only. Respondents agreed there is a timely need for pediatric consensus guidelines on CLAD detection and monitoring.
慢性肺移植物功能障碍（CLAD）仍然对儿科肺移植（LTx）受者的生存产生负面影响。目前的共识指南主要针对成人。我们试图检查儿科 LTx 计划中 CLAD 的检测和监测实践。
我们在国际儿科肺移植协作组织中进行了一项调查。问题包括从业者的经验、LTx 计划的人口统计学以及用于 CLAD 监测和检测的查询测试。调查询问了以下内容：胸部 X 线（CXR）、胸部计算机断层扫描（CT）、肺磁共振成像（MRI）、通气/灌注扫描、常规肺功能测试（PFT）、多呼吸冲洗（MBW）、婴儿/学龄前 PFT、支气管肺泡灌洗、经支气管活检（TBBx）或其他组织取样技术。根据五点李克特量表，对某些模式优于其他模式的偏好进行了询问。
25 个计划中有 24 个做出了回应。胸部 CT 和 CXR 通常用于 CLAD 的监测和检测。没有计划在临床上使用肺 MRI，它在未来可能具有一些效用。虽然所有中心都使用常规 PFT，但 MBW 和婴儿/学龄前 PFT 分别在五分之一和三分之一的中心使用。虽然大多数中心都使用 TBBx，但如果怀疑 CLAD，只有 41.7%的中心会根据组织组织病理学而不是非侵入性技术做出诊断。生物标志物的使用仍然有限。
我们的结果表明，在大多数中心中，常规 PFT 与胸部 CT 一起使用，而较少使用 CXR 来检测和监测 CLAD。只有少数中心使用婴儿/学龄前 PFT 和 MBW 等新方法。受访者一致认为，及时需要制定儿科 CLAD 检测和监测共识指南。
