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Habert P, Chetrit E, Coiffard B, Bregeon F, Thomas P, Loundou A, Bermudez J, Reynaud-Gaubert M, Gaubert JY. Early chest CT abnormalities to predict the subsequent occurrence of chronic lung allograft dysfunction. Insights Imaging 2023; 14:154. [PMID: 37741923 PMCID: PMC10517910 DOI: 10.1186/s13244-023-01509-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/12/2023] [Indexed: 09/25/2023] Open
Abstract
INTRODUCTION Chronic lung allograft dysfunction (CLAD) can take two forms: bronchiolitis obliterans syndrome (BOS) or restrictive allograft syndrome (RAS). The aim was to determine if chest-CT abnormalities after lung transplantation (LTx) could predict CLAD before respiratory functional deterioration. MATERIALS AND METHODS This monocentric retrospective study analyzed consecutive patients who underwent LTx from January 2015 to December 2018. Initial CT post-LTx (CTi) and a follow-up CT at least 9 months post-LTx (CTf) were reviewed. CLAD was defined as a persistent respiratory functional decline (> 20% of basal FEV1) outside acute episode. A Cox regression was performed in univariate, then in multivariate analysis (including features with p < 0.01 in univariate or of clinical importance) to determine risk factors for CLAD. Subgroup analyses were made for BOS, RAS, and death. RESULTS Among 118 LTx patients (median (min-max) 47 (18-68) years), 25 developed CLAD during follow-up (19 BOS). The median time to CLAD since LTx was 570 days [150-1770]. Moderate pulmonary artery stenosis (30-50%) was associated with the occurrence of CLAD on CTi (hazard ratio HR = 4.6, CI [1.6-13.2]) and consolidations and pleural effusion on CTf (HR = 2.6, CI [1.3-4.9] and HR = 4.5, CI [1.5-13.6] respectively). The presence of mosaic attenuation (HR = 4.1, CI [1.4-12.5]), consolidations (HR = 2.6, CI [1.3-5.4]), and pleural effusions (p = 0.01, HR = 5.7, CI [1.4-22.3]) were risk factors for BOS on CTf. The consolidations (p = 0.029) and pleural effusions (p = 0.001) were risk factors for death on CTf. CONCLUSIONS CTi and CTf in the monitoring of LTx patients could predict CLAD. Moderate pulmonary artery stenosis, mosaic pattern, parenchyma condensations, and pleural effusions were risk factors for CLAD. CRITICAL RELEVANCE STATEMENT There is a potential predictive role of chest CT in the follow-up of LTx patients for chronic lung allograft dysfunction (CLAD). Early chest CT should focus on pulmonary artery stenosis (risk factor for CLAD in this study). During the follow-up (at least 9 months post-LTx), parenchymal consolidations and pleural effusions were shown to be risk factors for CLAD, and death in subgroup analyses. KEY POINTS • Pulmonary artery stenosis (30-50%) on initial chest-CT following lung transplantation predicts CLAD HR = 4.5; CI [1.6-13.2]. • Pleural effusion and consolidations 1 year after lung transplantation predict CLAD and death. • Early evaluation of lung transplanted patients should evaluate pulmonary artery anastomosis.
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Affiliation(s)
- Paul Habert
- Service de radiologie, Hôpital Nord, Chemin des Bourrely, 13015, Marseille, France.
- Aix Marseille Univ, LIIE, Marseille, France.
- Aix Marseille Univ, CERIMED, Marseille, France.
| | - Elsa Chetrit
- Service de radiologie, Hôpital Nord, Chemin des Bourrely, 13015, Marseille, France
| | - Benjamin Coiffard
- Centre de Ressources et de Compétences de la Mucoviscidose (CRCM) Adulte, AP-HM Hôpital Nord, 13015, Marseille, France
| | - Fabienne Bregeon
- APHM, Hôpital Nord, Explorations Fonctionnelles Respiratoires, Marseille, France
- Aix Marseille Univ, APHM, Microbes Evolution Phylogeny and Infections (MEPHI), IHU-Méditerranée Infection, Marseille, France
| | - Pascal Thomas
- Service de chirurgie thoracique, Hôpital Nord, chemin des Bourrely, 13015, Marseille, France
| | - Anderson Loundou
- Aix-Marseille Univ, - CEReSS UR3279-Health Service Research and Quality of Life Center, Marseille, France
- Department of Public Health, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Julien Bermudez
- Centre de Ressources et de Compétences de la Mucoviscidose (CRCM) Adulte, AP-HM Hôpital Nord, 13015, Marseille, France
| | - Martine Reynaud-Gaubert
- Centre de Ressources et de Compétences de la Mucoviscidose (CRCM) Adulte, AP-HM Hôpital Nord, 13015, Marseille, France
| | - Jean-Yves Gaubert
- Aix Marseille Univ, LIIE, Marseille, France
- Aix Marseille Univ, CERIMED, Marseille, France
- Service de radiologie, La Timone Hôpital, 264 rue Saint Pierre, 13005, Marseille, France
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Bourinet V, Raguin T, Fortin M, Chetrit E, Guinde J, Laroumagne S, Fakhry N, Astoul P, Debry C, Dutau H. Experience with Transcordal Silicone Stents in Adult Laryngotracheal Stenosis: A Bicentric Retrospective Study. Respiration 2018; 95:441-448. [PMID: 29621756 DOI: 10.1159/000487242] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/25/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Benign stenosis involving laryngeal and upper tracheal structures represents a therapeutic challenge. Open surgery and endoscopic management have to be discussed by a multidisciplinary board in order to evaluate the risk and benefit for each patient. OBJECTIVE The objective of this retrospective study was to report the experience of two French centers with transcordal silicone stents (TSS) in the endoscopic management of benign laryngotracheal stenosis (BLTS) in adults, with focus on efficacy, safety, and tolerability. METHODS We performed a retrospective chart review of all cases of BLTS treated with TSS between January 2001 and June 2017 at two tertiary centers in France: the Centre Hospitalier Régional Universitaire de Strasbourg and the Hôpital Nord de Marseille. RESULTS A total of 17 patients were included. Eleven had a tracheostomy at initial management which consisted of 8 T-tubes and 9 strictly endoluminal stents placements. The main complications were minor aspirations in 5 patients (29%), granulation in 3 patients (18%), migration in 2 patients (12%), and severe dysphonia in 3 patients (18%). After a mean duration of 18.3 months, 11 patients (65%) had had their TSS definitely removed, 13 patients were tracheostomy free (76%), and a TSS remained in place in 4 patients (24%). CONCLUSIONS Adult BLTS treatment with TSS placement is associated with low morbidity and excellent clinical outcomes, with a large proportion of patients free of airway instrumentation on long-term follow-up.
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Affiliation(s)
- Valerian Bourinet
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North Hospital of Marseille, Aix-Marseille University, Marseille, France
| | - Thibaut Raguin
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Marc Fortin
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North Hospital of Marseille, Aix-Marseille University, Marseille, France
| | - Elsa Chetrit
- Department of Radiology, North Hospital of Marseille, Aix-Marseille University, Marseille, France
| | - Julien Guinde
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North Hospital of Marseille, Aix-Marseille University, Marseille, France
| | - Sophie Laroumagne
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North Hospital of Marseille, Aix-Marseille University, Marseille, France
| | - Nicolas Fakhry
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Marseille, Marseille, France.,Aix-Marseille University, Marseille, France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North Hospital of Marseille, Aix-Marseille University, Marseille, France.,Aix-Marseille University, Marseille, France
| | - Christian Debry
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Hervé Dutau
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North Hospital of Marseille, Aix-Marseille University, Marseille, France
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