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Gerckens M, Mümmler C, Richard A, Strodel J, Mertsch P, Milger K, Veit T, Gade N, Yildirim AÖ, Schneider C, Kauke T, Michel S, Irlbeck M, Behr J, Kneidinger N. Characterization of Baseline Lung Allograft Dysfunction in Single Lung Transplant Recipients. Transplantation 2024:00007890-990000000-00868. [PMID: 39250332 DOI: 10.1097/tp.0000000000005189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
BACKGROUND Baseline lung allograft dysfunction (BLAD) is characterized by the failure to achieve normal baseline lung function after double lung transplantation (DLTX) and is associated with a high risk of mortality. In single lung transplant (SLTX) recipients, however, cutoff values and associated factors have not been explored. Here, we aimed to define BLAD in SLTX recipients, investigate its impact on allograft survival, and identify potential risk factors for BLAD in SLTX recipients. METHODS We performed a retrospective, single-center analysis of the LTX cohort of LMU Munich between 2010 and 2018. In accordance with DLTX cutoffs, BLAD in SLTX recipients was defined as failure to achieve percentage of forced expiratory volume in 1 s and percentage of forced vital capacity of >60% on 2 consecutive tests >3 wk apart. Survival analysis and regression analysis for potential predictors of BLAD were performed. RESULTS In a cohort of 141 SLTX recipients, 43% of patients met BLAD criteria. SLTX recipients with BLAD demonstrated impaired survival. Native lung hyperinflation was associated with BLAD in obstructive disease, whereas donor/recipient lung size mismatch was associated with BLAD in both obstructive and restrictive underlying diseases. Pulmonary function testing at 3 mo after lung transplantation predicted normal baseline lung function in SLTX recipients with obstructive lung disease. CONCLUSIONS BLAD in SLTX recipients is as relevant as in DLTX recipients and should generally be considered in the follow-up of LTX recipients. Risk factors for BLAD differed between underlying obstructive and restrictive lung disease. A better understanding of associated factors may help in the development of preventive strategies.
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Affiliation(s)
- Michael Gerckens
- Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center (CPC), Member of the German Center of Lung Research (DZL), LMU Munich, Munich, Germany
- Institute of Lung Health and Immunity (LHI), Comprehensive Pneumology Center (CPC), Helmholtz Munich, Member of the German Center of Lung Research (DZL), LMU Munich, Munich, Germany
| | - Carlo Mümmler
- Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center (CPC), Member of the German Center of Lung Research (DZL), LMU Munich, Munich, Germany
- Institute of Lung Health and Immunity (LHI), Comprehensive Pneumology Center (CPC), Helmholtz Munich, Member of the German Center of Lung Research (DZL), LMU Munich, Munich, Germany
| | - Alexander Richard
- Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center (CPC), Member of the German Center of Lung Research (DZL), LMU Munich, Munich, Germany
| | - Johannes Strodel
- Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center (CPC), Member of the German Center of Lung Research (DZL), LMU Munich, Munich, Germany
| | - Pontus Mertsch
- Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center (CPC), Member of the German Center of Lung Research (DZL), LMU Munich, Munich, Germany
| | - Katrin Milger
- Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center (CPC), Member of the German Center of Lung Research (DZL), LMU Munich, Munich, Germany
| | - Tobias Veit
- Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center (CPC), Member of the German Center of Lung Research (DZL), LMU Munich, Munich, Germany
| | - Nils Gade
- Department of Internal Medicine I, University Hospital, LMU Munich, Munich, Germany
| | - Ali Önder Yildirim
- Institute of Lung Health and Immunity (LHI), Comprehensive Pneumology Center (CPC), Helmholtz Munich, Member of the German Center of Lung Research (DZL), LMU Munich, Munich, Germany
- Institute of Experimental Pneumology, LMU University Hospital, Ludwig Maximilians University of Munich, LMU Munich, Munich, Germany
| | - Christian Schneider
- Division of Thoracic Surgery, LMU University Hospital, LMU Munich, Munich, Germany
| | - Teresa Kauke
- Division of Thoracic Surgery, LMU University Hospital, LMU Munich, Munich, Germany
| | - Sebastian Michel
- Institute of Lung Health and Immunity (LHI), Comprehensive Pneumology Center (CPC), Helmholtz Munich, Member of the German Center of Lung Research (DZL), LMU Munich, Munich, Germany
- Department of Cardiac Surgery, LMU University Hospital, LMU Munich, Munich, Germany
| | - Michael Irlbeck
- Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Jürgen Behr
- Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center (CPC), Member of the German Center of Lung Research (DZL), LMU Munich, Munich, Germany
| | - Nikolaus Kneidinger
- Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center (CPC), Member of the German Center of Lung Research (DZL), LMU Munich, Munich, Germany
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Hagiwara A, Yamatani I, Kudoh R, Hiramatsu K, Kadota JI, Komiya K. Association between the cardiothoracic ratio on chest X-rays and the respiratory function in patients with interstitial lung diseases: A cross-sectional study. Intern Med 2024:4104-24. [PMID: 39198168 DOI: 10.2169/internalmedicine.4104-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2024] Open
Abstract
Objective Patients with advanced interstitial lung disease (ILD) struggle to undergo spirometry to evaluate the respiratory function. The cardiothoracic ratio (CTR) on chest radiography can potentially reflect the lung volume; however, this has not yet been fully established. This study aimed to clarify the relationship between the CTR and the respiratory function in patients with interstitial lung diseases. Patients and Methods We reviewed 120 consecutive patients with idiopathic interstitial lung disease who were admitted to our department between April 2018 and March 2023 and who underwent chest radiography, spirometry, and echocardiography. A multiple linear regression analysis was used to identify the factors associated with the CTR. Correlations between the CTR and the respiratory or cardiac function were assessed using Pearson's correlation coefficient. Results A multiple linear regression analysis showed the percent vital capacity (β = -0.598, p <0.001), age (β = 0.405, p <0.001), and female sex (β = 0.177, p = 0.047) to be independently associated with the CTR, whereas no relationship was observed between the left ventricular ejection fraction, body mass index, and smoking habits. The CTR was significantly negatively correlated with the vital capacity (r = -0.490, p <0.001). Conclusions An increased CTR might reflect a decreased vital capacity, but not a decreased cardiac function, in patients with interstitial lung diseases. Measuring the CTR can thus be beneficial for predicting progression in patients with ILD.
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Affiliation(s)
- Akihiko Hagiwara
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
| | - Izumi Yamatani
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
- Department of Mycobacterium Reference and Research, the Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Japan
| | - Ryohei Kudoh
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
| | - Kazufumi Hiramatsu
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
| | - Jun-Ichi Kadota
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
| | - Kosaku Komiya
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
- Research Center for Global and Local Infectious Diseases, Oita University Faculty of Medicine, Japan
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3
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Ismail MK, Araki T, Gefter WB, Suzuki Y, Raevsky A, Saleh A, Yusuf S, Marquis A, Alcudia A, Duncan I, Schaubel DE, Cantu E, Rizi R. Artificial intelligence-driven automated lung sizing from chest radiographs. Am J Transplant 2024:S1600-6135(24)00524-0. [PMID: 39182615 DOI: 10.1016/j.ajt.2024.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 08/27/2024]
Abstract
Lung size measurements play an important role in transplantation, as optimal donor-recipient size matching is necessary to ensure the best possible outcome. Although several strategies for size matching are currently used, all have limitations, and none has proven superior. In this pilot study, we leveraged deep learning and computer vision to develop an automated system for generating standardized lung size measurements using portable chest radiographs to improve accuracy, reduce variability, and streamline donor/recipient matching. We developed a 2-step framework involving lung mask extraction from chest radiographs followed by feature point detection to generate 6 distinct lung height and width measurements, which we validated against measurements reported by 2 radiologists (M.K.I. and R.R.) for 50 lung transplant recipients. Our system demonstrated <2.5% error (<7.0 mm) with robust interrater and intrarater agreement compared with an expert radiologist review. This is especially promising given that the radiographs used in this study were purposely chosen to include images with technical challenges such as consolidations, effusions, and patient rotation. Although validation in a larger cohort is necessary, this study highlights artificial intelligence's potential to both provide reproducible lung size assessment in real patients and enable studies on the effect of lung size matching on transplant outcomes in large data sets.
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Affiliation(s)
- Mostafa K Ismail
- Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tetsuro Araki
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Warren B Gefter
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yoshikazu Suzuki
- Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Allie Raevsky
- Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aya Saleh
- Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sophia Yusuf
- Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Abigail Marquis
- Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alyster Alcudia
- Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ian Duncan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Douglas E Schaubel
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Edward Cantu
- Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Rahim Rizi
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Prabhu NK, Wong MK, Klapper JA, Haney JC, Mazurowski MA, Mammarappallil JG, Hartwig MG. Computed Tomography Volumetrics for Size Matching in Lung Transplantation for Restrictive Disease. Ann Thorac Surg 2024; 117:413-421. [PMID: 37031770 DOI: 10.1016/j.athoracsur.2023.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/08/2023] [Accepted: 03/26/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND There is no consensus on the optimal allograft sizing strategy for lung transplantation in restrictive lung disease. Current methods that are based on predicted total lung capacity (pTLC) ratios do not account for the diminutive recipient chest size. The study investigators hypothesized that a new sizing ratio incorporating preoperative recipient computed tomographic lung volumes (CTVol) would be associated with postoperative outcomes. METHODS A retrospective single-institution study was conducted of adults undergoing primary bilateral lung transplantation between January 2016 and July 2020 for restrictive lung disease. CTVol was computed for recipients by using advanced segmentation software. Two sizing ratios were calculated: pTLC ratio (pTLCdonor/pTLCrecipient) and a new volumetric ratio (pTLCdonor/CTVolrecipient). Patients were divided into reference, oversized, and undersized groups on the basis of ratio quintiles, and multivariable models were used to assess the effect of the ratios on primary graft dysfunction and survival. RESULTS CTVol was successfully acquired in 218 of 220 (99.1%) patients. In adjusted analysis, undersizing on the basis of the volumetric ratio was independently associated with decreased primary graft dysfunction grade 2 or 3 within 72 hours (odds ratio, 0.42; 95% CI, 0.20-0.87; P =.02). The pTLC ratio was not significantly associated with primary graft dysfunction. Oversizing on the basis of the volumetric ratio was independently associated with an increased risk of death (hazard ratio, 2.27; 95% CI, 1.04-4.99; P =.04], whereas the pTLC ratio did not have a significant survival association. CONCLUSIONS Using computed tomography-acquired lung volumes for donor-recipient size matching in lung transplantation is feasible with advanced segmentation software. This method may be more predictive of outcome compared with current sizing methods, which use gender and height only.
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Affiliation(s)
- Neel K Prabhu
- Duke University School of Medicine, Durham, North Carolina.
| | - Megan K Wong
- Duke University School of Medicine, Durham, North Carolina
| | - Jacob A Klapper
- Duke University School of Medicine, Durham, North Carolina; Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - John C Haney
- Duke University School of Medicine, Durham, North Carolina; Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Maciej A Mazurowski
- Duke University School of Medicine, Durham, North Carolina; Department of Computer Science, Duke University, Durham, North Carolina; Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina; Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Joseph G Mammarappallil
- Duke University School of Medicine, Durham, North Carolina; Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Matthew G Hartwig
- Duke University School of Medicine, Durham, North Carolina; Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Sim JPY, Nilsen K, Borg BM, Levvey B, Vazirani J, Ennis S, Plit M, Snell GI, Darley DR, Tonga KO. Oscillometry in Stable Single and Double Lung Allograft Recipients Transplanted for Interstitial Lung Disease: Results of a Multi-Center Australian Study. Transpl Int 2023; 36:11758. [PMID: 38116170 PMCID: PMC10728296 DOI: 10.3389/ti.2023.11758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/14/2023] [Indexed: 12/21/2023]
Abstract
Peak spirometry after single lung transplantation (SLTx) for interstitial lung disease (ILD) is lower than after double lung transplantation (DLTx), however the pathophysiologic mechanisms are unclear. We aim to assess respiratory mechanics in SLTx and DLTx for ILD using oscillometry. Spirometry and oscillometry (tremoflo® C-100) were performed in stable SLTx and DLTx recipients in a multi-center study. Resistance (R5, R5-19) and reactance (X5) were compared between LTx recipient groups, matched by age and gender. A model of respiratory impedance using ILD and DLTx data was performed. In total, 45 stable LTx recipients were recruited (SLTx n = 23, DLTx n = 22; males: 87.0% vs. 77.3%; median age 63.0 vs. 63.0 years). Spirometry was significantly lower after SLTx compared with DLTx: %-predicted mean (SD) FEV1 [70.0 (14.5) vs. 93.5 (26.0)%]; FVC [70.5 (16.8) vs. 90.7 (12.8)%], p < 0.01. R5 and R5-19 were similar between groups (p = 0.94 and p = 0.11, respectively) yet X5 was significantly worse after SLTx: median (IQR) X5 [-1.88 (-2.89 to -1.39) vs. -1.22 (-1.87 to -0.86)] cmH2O.s/L], p < 0.01. R5 and X5 measurements from the model were congruent with measurements in SLTx recipients. The similarities in resistance, yet differences in spirometry and reactance between both transplant groups suggest the important contribution of elastic properties to the pathophysiology. Oscillometry may provide further insight into the physiological changes occurring post-LTx.
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Affiliation(s)
- Joan P. Y. Sim
- Lung Transplant and Thoracic Medicine Unit, St Vincent’s Hospital, Sydney, NSW, Australia
- St Vincent’s Hospital Clinical Campus, Faculty of Medicine and Health, The University of New South Wales, Sydney, NSW, Australia
| | - Kristopher Nilsen
- Lung Transplant and Respiratory Medicine Service, The Alfred Hospital, Melbourne, VIC, Australia
| | - Brigitte M. Borg
- Lung Transplant and Respiratory Medicine Service, The Alfred Hospital, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Bronwyn Levvey
- Lung Transplant and Respiratory Medicine Service, The Alfred Hospital, Melbourne, VIC, Australia
- Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VIC, Australia
| | - Jaideep Vazirani
- Lung Transplant and Respiratory Medicine Service, The Alfred Hospital, Melbourne, VIC, Australia
| | - Samantha Ennis
- Lung Transplant and Respiratory Medicine Service, The Alfred Hospital, Melbourne, VIC, Australia
| | - Marshall Plit
- Lung Transplant and Thoracic Medicine Unit, St Vincent’s Hospital, Sydney, NSW, Australia
- St Vincent’s Hospital Clinical Campus, Faculty of Medicine and Health, The University of New South Wales, Sydney, NSW, Australia
| | - Gregory I. Snell
- Lung Transplant and Respiratory Medicine Service, The Alfred Hospital, Melbourne, VIC, Australia
- Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VIC, Australia
| | - David R. Darley
- Lung Transplant and Thoracic Medicine Unit, St Vincent’s Hospital, Sydney, NSW, Australia
- St Vincent’s Hospital Clinical Campus, Faculty of Medicine and Health, The University of New South Wales, Sydney, NSW, Australia
| | - Katrina O. Tonga
- Lung Transplant and Thoracic Medicine Unit, St Vincent’s Hospital, Sydney, NSW, Australia
- St Vincent’s Hospital Clinical Campus, Faculty of Medicine and Health, The University of New South Wales, Sydney, NSW, Australia
- Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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6
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Rui W, Yuhang S, Yang L, Yue Y, Ze T, Yujie Z, Xiaochao M, Da Q, Youbin C, Tianyu L. A new method for evaluating lung volume: AI-3D reconstruction. Front Physiol 2023; 14:1217411. [PMID: 37781229 PMCID: PMC10538118 DOI: 10.3389/fphys.2023.1217411] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/07/2023] [Indexed: 10/03/2023] Open
Abstract
Objective: This study aims to explore the clinical application of an AI-3D reconstruction system in measuring lung volume and analyze its practical value in donor-recipient size matching in lung transplantation. Methods: The study retrospectively collected data from 75 subjects who underwent a plethysmography examination and lung CT at the First Hospital of Jilin University. General data and information related to lung function, and imaging results were collected. The correlation between actual total lung volume (aTLV), predicted total lung volume (pTLV), and artificial intelligence three-dimensional reconstruction CT lung volume (AI-3DCTVol) was analyzed for the overall, male, and female groups. The correlation coefficient and the absolute error percentage with pTLV and AI-3DCTVol were obtained. Results: In the overall, male, and female groups, there were statistical differences (p <0.05) between the pTLV formula and AI-3D reconstruction compared to the plethysmography examination value. The ICC between pTLV and aTLV for all study participants was 0.788 (95% CI: 0.515-0.893), p <0.001. Additionally, the ICC value between AI-3D reconstruction and aTLV was 0.792 (95% CI: 0.681-0.866), p <0.001. For male study participants, the ICC between pTLV and aTLV was 0.330 (95% CI: 0.032-0.617), p = 0.006. Similarly, the ICC value between AI-3D reconstruction and aTLV was 0.413 (95% CI: 0.089-0.662), p = 0.007. In the case of female research subjects, the ICC between pTLV and aTLV was 0.279 (95% CI: 0.001-0.523), p = 0.012. Further, the ICC value between AI-3D reconstruction and aTLV was 0.615 (95% CI: 0.561-0.870), p <0.001. Conclusion: The AI-3D reconstruction, as a convenient method, has significant potential for application in lung transplantation.
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Affiliation(s)
- Wang Rui
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, China
- School of Public Health, Jilin University, Changchun, China
| | - Shang Yuhang
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Li Yang
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Yang Yue
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Tang Ze
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Zhao Yujie
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, China
- Department of Critical Medicine, The First Affiliated Hospital of Jiamusi University, Jiamusi, China
| | - Ma Xiaochao
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Qin Da
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Cui Youbin
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Lu Tianyu
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, China
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Vazquez Guillamet R, Rjob A, Bierhals A, Tague L, Marklin G, Halverson L, Witt C, Byers D, Hachem R, Gierada D, Brody SL, Takahashi T, Nava R, Kreisel D, Puri V, Trulock EP. Potential Role of Computed Tomography Volumetry in Size Matching in Lung Transplantation. Transplant Proc 2023; 55:432-439. [PMID: 36914438 PMCID: PMC10225152 DOI: 10.1016/j.transproceed.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Accumulated knowledge on the outcomes related to size mismatch in lung transplantation derives from predicted total lung capacity equations rather than individualized measurements of donors and recipients. The increasing availability of computed tomography (CT) makes it possible to measure the lung volumes of donors and recipients before transplantation. We hypothesize that CT-derived lung volumes predict a need for surgical graft reduction and primary graft dysfunction. METHODS Donors from the local organ procurement organization and recipients from our hospital from 2012 to 2018 were included if their CT exams were available. The CT lung volumes and plethysmography total lung capacity were measured and compared with predicted total lung capacity using Bland Altman methods. We used logistic regression to predict the need for surgical graft reduction and ordinal logistic regression to stratify the risk for primary graft dysfunction. RESULTS A total of 315 transplant candidates with 575 CT scans and 379 donors with 379 CT scans were included. The CT lung volumes closely approximated plethysmography lung volumes and differed from the predicted total lung capacity in transplant candidates. In donors, CT lung volumes systematically underestimated predicted total lung capacity. Ninety-four donors and recipients were matched and transplanted locally. Larger donor and smaller recipient lung volumes estimated by CT predicted a need for surgical graft reduction and were associated with higher primary graft dysfunction grade. CONCLUSION The CT lung volumes predicted the need for surgical graft reduction and primary graft dysfunction grade. Adding CT-derived lung volumes to the donor-recipient matching process may improve recipients' outcomes.
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Affiliation(s)
- Rodrigo Vazquez Guillamet
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri.
| | - Ashraf Rjob
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri
| | - Andrew Bierhals
- Mallinckrodt Institute of Radiology, Washington University, St Louis, Missouri
| | - Laneshia Tague
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri
| | - Gary Marklin
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri
| | - Laura Halverson
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri
| | - Chad Witt
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri
| | - Derek Byers
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri
| | - Ramsey Hachem
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri
| | - David Gierada
- Mallinckrodt Institute of Radiology, Washington University, St Louis, Missouri
| | - Steven L Brody
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri; Mallinckrodt Institute of Radiology, Washington University, St Louis, Missouri
| | - Tsuyoshi Takahashi
- Department of Surgery, Division of Thoracic Surgery, Washington University, St Louis, Missouri
| | - Ruben Nava
- Department of Surgery, Division of Thoracic Surgery, Washington University, St Louis, Missouri
| | - Daniel Kreisel
- Department of Surgery, Division of Thoracic Surgery, Washington University, St Louis, Missouri
| | - Varun Puri
- Department of Surgery, Division of Thoracic Surgery, Washington University, St Louis, Missouri
| | - Elbert P Trulock
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri
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8
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Hirdman G, Niroomand A, Olm F, Lindstedt S. Taking a Deep Breath: an Examination of Current Controversies in Surgical Procedures in Lung Transplantation. CURRENT TRANSPLANTATION REPORTS 2022; 9:160-172. [PMID: 35601346 PMCID: PMC9108015 DOI: 10.1007/s40472-022-00367-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/30/2022]
Abstract
Purpose of Review This article reviews controversial questions within the field of lung transplantation, with a focus on data generated within the last 3 years. We aim to summarize differing opinions on a selection of topics, including bridge-to-transplantation, intraoperative machine circulatory support, bronchial anastomosis, size mismatch, delayed chest closure, and ex vivo lung perfusion. Recent Findings With the growing rate of lung transplantations worldwide and increasing numbers of patients placed on waiting lists, the importance of determining best practices has only increased in recent years. Factors which promote successful outcomes have been identified across all the topics, with certain approaches promoted, such as ambulation in bridge-to-transplant and widespread intraoperative ECMO as machine support. Summary While great strides have been made in the operative procedures involved in lung transplantation, there are still key questions to be answered. The consensus which can be reached will be instrumental in further improving outcomes in recipients.
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Affiliation(s)
- Gabriel Hirdman
- Department of Cardiothoracic Surgery and Transplantation, Skåne University Hospital, Lund University, Lund, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Anna Niroomand
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Lund Stem Cell Center, Lund University, Lund, Sweden
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ USA
| | - Franziska Olm
- Department of Cardiothoracic Surgery and Transplantation, Skåne University Hospital, Lund University, Lund, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Sandra Lindstedt
- Department of Cardiothoracic Surgery and Transplantation, Skåne University Hospital, Lund University, Lund, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Lund Stem Cell Center, Lund University, Lund, Sweden
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Orbach MR, Servaes SE, Mayer OH, Cahill PJ, Balasubramanian S. Quantifying lung and diaphragm morphology using radiographs in normative pediatric subjects, and predicting CT-derived lung volume. Pediatr Pulmonol 2021; 56:2177-2185. [PMID: 33860632 DOI: 10.1002/ppul.25429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/03/2021] [Accepted: 04/11/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To quantify the effect of age on two-dimensional (2D) radiographic lung and diaphragm morphology and determine if 2D radiographic lung measurements can be used to estimate computer tomography (CT)-derived lung volume in normative pediatric subjects. MATERIALS AND METHODS Digitally reconstructed radiographs (DRRs) were created using retrospective chest CT scans from 77 pediatric male and female subjects aged birth to 19 years. 2D lung and diaphragm measurements were made on the DRRs using custom MATLAB code, and Spearman correlations and exponential regression equations were used to relate 2D measurements with age. In addition, 3D lung volumes were segmented using CT scans, and power regression equations were fitted to predict each lung's CT-derived volume from 2D lung measurements. The coefficient of determination (R2 ) and standard error of the estimate (SEE) were used to assess the precision of the predictive equations with p < .05 indicating statistical significance. RESULTS All 2D radiographic lung and diaphragm measurements showed statistically significant positive correlations with age (p < .01), including lung major axis (Spearman rho ≥ 0.90). Precise estimations of CT-derived lung volumes can be made using 2D lung measurements (R2 ≥ 0.95), including lung major axis (R2 ≥ 0.97). INTERPRETATIONS The reported pediatric age-specific reference data on 2D lung and diaphragm morphology and growth rates could be clinically used to identify lung and diaphragm pathologies during chest X-ray evaluations. The simple, precise, and clinically adaptable radiographic method for estimating CT-derived lung volumes may be used when pulmonary function tests are not readily available or difficult to perform.
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Affiliation(s)
- Mattan R Orbach
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Sabah E Servaes
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Oscar H Mayer
- Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Patrick J Cahill
- Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sriram Balasubramanian
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
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A simplified strategy for donor-recipient size-matching in lung transplant for interstitial lung disease. J Heart Lung Transplant 2021; 40:1422-1430. [PMID: 34301464 DOI: 10.1016/j.healun.2021.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Donor-recipient size-matching has been repeatedly reported to improve outcomes following lung transplantation (LTx). However, there is significant variability in practice and the optimal strategy for size-matching is yet to be defined. For recipients with ILD, size-matching decisions are complicated by concerns regarding the potential impact of pre-LTx pulmonary restriction. We evaluate whether a specific donor-to-recipient size-matching strategy, based on predicted total lung capacity, benefits this patient group. METHODS This retrospective, single-centre, cohort study describes the post-LTx outcomes of adults who underwent LTx for ILD between 1983 and 2020. Only patients with restrictive physiology, based on pre-LTx pulmonary function testing were included. Post-LTx outcomes were compared based on donor-recipient predicted TLC (D-R pTLC) ratio. A D-R pTLC ratio of ≥0.8 or <1.2 for DLTx, and a D-R pTLC ratio of ≥0.8 or <1.0 for SLTx were classified as 'size-matched'. RESULTS Five-hundred and fifty LTx recipients met inclusion criteria. Of these, 404 underwent DLTx and 146 underwent SLTx. Size-matching was achieved in 78% of DLTx and 47% of SLTx. Overall survival (p = 0.007) and CLAD-free survival (p < 0.001) was significantly improved following a size-matched DLTx, compared to those with D-R pTLC ratios <0.8 or ≥1.2. Size-matching based on a D-R pTLC ratio 0.8≥ <1.0 for SLTX did not significantly improve survival. CONCLUSIONS D-R pTLC size-matching, based on a ratio of 0.8≥ <1.2 improved post-DLTx outcomes for patients with restrictive lung disease. This is simple to do, and if applied clinically, could improve overall outcomes in lung transplantation.
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Dai SH, Chen LJ, Qi WH, Ye CL, Zou GW, Liu WC, Yu BT, Tang J. microRNA-145 Inhibition Upregulates SIRT1 and Attenuates Autophagy in a Mouse Model of Lung Ischemia/Reperfusion Injury via NF-κB-dependent Beclin 1. Transplantation 2021; 105:529-539. [PMID: 32852406 DOI: 10.1097/tp.0000000000003435] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND MicroRNA-145 (miR-145) has been shown to play a critical role in ischemia/reperfusion (I/R) injury; however, the expression and function of miR-145 in lung I/R injury have not been reported yet. This study aimed to elucidate the potential effects of miR-145 in lung I/R injury. METHODS Lung I/R mice models and hypoxia/reoxygenation (H/R) pulmonary microvascular endothelial cell models were established. The expression of miR-145 and sirtuin 1 (SIRT1) was measured with reverse transcription-quantitative polymerase chain reaction and Western blot analysis in mouse lung tissue and cells. Artificial modulation of miR-145 and SIRT1 (downregulation) was done in I/R mice and H/R cells. Additionally, Pao2/FiO2 ratio, wet weight-to-dry weight ratio, and cell apoptosis in mouse lung tissues were determined by blood gas analyzer, electronic balance, and deoxyuridine triphosphate-biotin nick end-labeling assay, respectively. Autophagy marker Beclin 1 and LC3 expression, NF-κB acetylation levels, and autophagy bodies were detected in cell H/R and mouse I/R models by Western blot analysis. pulmonary microvascular endothelial cell apoptosis was detected with flow cytometry. RESULTS miR-145 was abundantly expressed in the lung tissue of mice and PMVECs following I/R injury. In addition, miR-145 directly targeted SIRT1, which led to significantly decreased Pao2/FiO2 ratio and increased wet weight-to-dry weight ratio, elevated acetylation levels and transcriptional activity of NF-κB, upregulated expressions of tumor necrosis factor-α, interleukins-6, and Beclin 1, autophagy bodies, cell apoptosis, as well as LC3-II/LC3I ratio. CONCLUSIONS In summary, miR-145 enhances autophagy and aggravates lung I/R injury by promoting NF-κB transcriptional activity via SIRT1 expression.
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Affiliation(s)
- Shao-Hua Dai
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lu-Jie Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wang-Hong Qi
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chun-Lin Ye
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Guo-Wen Zou
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei-Cheng Liu
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ben-Tong Yu
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jian Tang
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Will the Donor Lungs Fit? Just Grab a Ruler. Transplantation 2021; 105:282-283. [PMID: 32229772 DOI: 10.1097/tp.0000000000003239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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