Lung Ultrasound to Phenotype Chronic Lung Allograft Dysfunction in Lung Transplant Recipients. A Prospective Observational Study

Davidsen, Jesper Rømhild; Laursen, Christian B.; Højlund, Mikkel; Lund, Thomas Kromann; Jeschke, Klaus Nielsen; Iversen, Martin; Kalhauge, Anna; Bendstrup, Elisabeth; Carlsen, Jørn; Perch, Michael; Henriksen, Daniel Pilsgaard; Schultz, Hans Henrik Lawaetz

doi:10.3390/jcm10051078

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Lung Ultrasound to Phenotype Chronic Lung Allograft Dysfunction in Lung Transplant Recipients. A Prospective Observational Study

Jesper Rømhild Davidsen

^1,2,3,4,*

Christian B. Laursen

^1,2,3,

Mikkel Højlund

⁵,

Thomas Kromann Lund

⁶,

Klaus Nielsen Jeschke

⁷

⁶,

⁸,

⁹

^6,10,

^6,10

Daniel Pilsgaard Henriksen

⁵

and

Hans Henrik Lawaetz Schultz

⁶

South Danish Center for Interstitial Lung Diseases (SCILS), Odense University Hospital, 5000 Odense, Denmark

Department of Respiratory Medicine, Odense University Hospital, 5000 Odense, Denmark

Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark

⁴

Odense Patient Data Explorative Network, Odense University Hospital, 5000 Odense, Denmark

⁵

Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, 5000 Odense, Denmark

⁶

Department of Cardiology, Section for Lung Transplantation, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark

⁷

Department of Respiratory Medicine, Copenhagen University Hospital, Hvidovre Hospital, 2650 Hvidovre, Denmark

⁸

Department of Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark

⁹

Center for Rare Lung Diseases, Department Respiratory Diseases and Allergy, Aarhus University Hospital, 8200 Aarhus, Denmark

¹⁰

Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark

Author to whom correspondence should be addressed.

Academic Editor: Hiroshi Ishii

J. Clin. Med. 2021, 10(5), 1078; https://doi.org/10.3390/jcm10051078

Received: 10 February 2021 / Revised: 2 March 2021 / Accepted: 4 March 2021 / Published: 5 March 2021

(This article belongs to the Special Issue Pleuroparenchymal Fibroelastosis: Obstacles and Challenges)

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Abstract

Background: Bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS) are two distinct phenotypes of chronic lung allograft dysfunction (CLAD) in lung transplant (LTx) recipients. Contrary to BOS, RAS can radiologically present with a pleuroparenchymal fibroelastosis (PPFE) pattern. This study investigates lung ultrasound (LUS) to identify potential surrogate markers of PPFE in order to distinguish CLAD phenotype RAS from BOS. Methods: A prospective cohort study performed at a National Lung Transplantation Center during June 2016 to December 2017. Patients were examined with LUS and high-resolution computed tomography of the thorax (HRCT). Results: Twenty-five CLAD patients (72% males, median age of 54 years) were included, corresponding to 19/6 BOS/RAS patients. LUS-identified pleural thickening was more pronounced in RAS vs. BOS patients (5.6 vs. 2.9 mm) compatible with PPFE on HRCT. LUS-identified pleural thickening as an indicator of PPFE in RAS patients’ upper lobes showed a sensitivity of 100% (95% CI; 54–100%), specificity of 100% (95% CI; 82–100%), PPV of 100% (95% CI; 54–100%), and NPV of 100% (95% CI; 82–100%). Conclusion: Apical pleural thickening detected by LUS and compatible with PPFE on HRCT separates RAS from BOS in patients with CLAD. We propose LUS as a supplementary tool for initial CLAD phenotyping. View Full-Text

Keywords: bronchiolitis obliterans syndrome; chronic lung allograft dysfunction; lung transplantation; lung ultrasound; pleuroparenchymal fibroelastosis; restrictive allograft syndrome

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MDPI and ACS Style

Davidsen, J.R.; Laursen, C.B.; Højlund, M.; Lund, T.K.; Jeschke, K.N.; Iversen, M.; Kalhauge, A.; Bendstrup, E.; Carlsen, J.; Perch, M.; Henriksen, D.P.; Schultz, H.H.L. Lung Ultrasound to Phenotype Chronic Lung Allograft Dysfunction in Lung Transplant Recipients. A Prospective Observational Study. J. Clin. Med. 2021, 10, 1078. https://doi.org/10.3390/jcm10051078

AMA Style

Davidsen JR, Laursen CB, Højlund M, Lund TK, Jeschke KN, Iversen M, Kalhauge A, Bendstrup E, Carlsen J, Perch M, Henriksen DP, Schultz HHL. Lung Ultrasound to Phenotype Chronic Lung Allograft Dysfunction in Lung Transplant Recipients. A Prospective Observational Study. Journal of Clinical Medicine. 2021; 10(5):1078. https://doi.org/10.3390/jcm10051078

Chicago/Turabian Style

Davidsen, Jesper R., Christian B. Laursen, Mikkel Højlund, Thomas K. Lund, Klaus N. Jeschke, Martin Iversen, Anna Kalhauge, Elisabeth Bendstrup, Jørn Carlsen, Michael Perch, Daniel P. Henriksen, and Hans H.L. Schultz. 2021. "Lung Ultrasound to Phenotype Chronic Lung Allograft Dysfunction in Lung Transplant Recipients. A Prospective Observational Study" Journal of Clinical Medicine 10, no. 5: 1078. https://doi.org/10.3390/jcm10051078

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Lung Ultrasound to Phenotype Chronic Lung Allograft Dysfunction in Lung Transplant Recipients. A Prospective Observational Study

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