Lung clearance index in detection of post-transplant bronchiolitis obliterans syndrome

Journal article


Driskel, Madeleine, Horsley, Alex, Fretwell, Laurice, Clayton, Nigel and Al-Aloul, Mohamed 2019. Lung clearance index in detection of post-transplant bronchiolitis obliterans syndrome. ERJ Open Research. https://doi.org/10.1183/23120541.00164-2019
AuthorsDriskel, Madeleine, Horsley, Alex, Fretwell, Laurice, Clayton, Nigel and Al-Aloul, Mohamed
Abstract

Long-term outcomes after lung transplantation are often limited by the development of obliterative bronchiolitis (OB), which is clinically defined using spirometry as bronchiolitis obliterans syndrome (BOS). Lung clearance index (LCI), derived from multiple breath washout (MBW) testing, is a global measure of ventilation heterogeneity that has previously been shown to be a more sensitive measure of obstructive small airway diseases than spirometry. We aimed to assess the feasibility of LCI in adult lung transplant patients and to compare LCI to BOS grade. 51 stable adult double-lung transplant recipients performed sulfur hexafluoride MBW in triplicate on a single occasion, using a closed-circuit Innocor device. BOS grades were derived from serial spirometry according to International Society for Heart and Lung Transplantation criteria and, where available, high-resolution computed tomography (HRCT) evidence of OB was recorded. LCI was successfully performed in 98% of patients. The within-visit coefficient of variation for repeat LCI measurements was 3.1%. Mean LCI increased significantly with BOS grades: no BOS (n=15), LCI 7.6; BOS-0p (n=16), LCI 8.3; BOS-1 (n=11), LCI 9.3; BOS-2–3 (n=9), LCI 13.2 (p<0.001). 27 patients had HRCT within 12 months. LCI in those with HRCT evidence of OB was higher than those without OB (11.1 versus 8.2, p=0.006). 47% patients displayed abnormal LCI (>7) despite a normal forced expiratory volume in 1 s (FEV1) (>80% of baseline). LCI measurement in lung transplant recipients is feasible and reproducible. LCI increased with increasing BOS grade. A significant proportion of this cohort had abnormal LCI with preserved FEV1, suggesting early subclinical small airway dysfunction, and supporting a role for MBW in the early identification of BOS.

KeywordsResearch Subject Categories::MEDICINE; lung transplant; obliterative bronchiolitis; ventilation
Year2019
JournalERJ Open Research
PublisherEuropean Respiratory Society
ISSN23120541
Digital Object Identifier (DOI)https://doi.org/10.1183/23120541.00164-2019
Web address (URL)http://hdl.handle.net/10545/624253
hdl:10545/624253
Publication dates15 Oct 2019
Publication process dates
Deposited25 Oct 2019, 11:04
Accepted16 Aug 2019
ContributorsLung Function Laboratory, Manchester University NHS Foundation Trust, Manchester, UK, Cardiothoracic Transplant Unit, Manchester University NHS Foundation Trust, Manchester, UK, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK and School of Human Sciences, University of Derby, Derby, UK
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