Restrictive allograft syndrome after lung transplantation: new radiological insights
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To describe the CT changes in patients with restrictive allograft syndrome (RAS) after lung transplantation, before and after clinical diagnosis.
This retrospective study included 22 patients with clinical diagnosis of RAS. Diagnosis was based on a combination of forced expiratory volume (FEV1) decline (≥20 %) and total lung capacity (TLC) decline (≥10 %). All available CT scans after transplantation were analyzed for the appearance and evolution of lung abnormalities.
In 14 patients, non-regressing nodules and reticulations predominantly affecting the upper lobes developed an average of 13.9 months prior to the diagnosis of RAS. Median graft survival after onset of non-regressing abnormalities was 33.5 months, with most patients in follow-up (9/14). In eight patients, a sudden appearance of diffuse consolidations mainly affecting both upper and lower lobes was seen an average of 2.8 months prior to the diagnosis of RAS. Median graft survival was 6.4 months after first onset of non-regressing abnormalities, with graft loss in most patients (6/8).
RAS has been previously described as a homogenous group. However, our study shows two different groups of RAS-patients: one with slow progression and one with fast progression. The two groups show different onset and progression patterns of CT abnormalities.
• RAS is the newest discovered form of chronic lung allograft dysfunction (CLAD).
• RAS is not a homogenous group, as survival varies greatly between patients.
• In this study, we see two different CT onset and progression patterns.
• These two different CT patterns also correlate with a different survival rate.
KeywordsComputed tomography Lung transplantation Organizing pneumonia Graft survival Pulmonary fibrosis
Restrictive allograft syndrome
Chronic lung allograft dysfunction
Bronchiolitis obliterans syndrome
Neutrophilic reversible allograft dysfunction
Azithromycin reversible allograft dysfunction
Forced expiratory volume in 1 second
Total lung capacity
Pulmonary function testing
Acute fibrinoid organizing pneumonia
Picture archiving and communication system
The scientific guarantor of this publication is Walter De Wever, MD PhD. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was not required for this study because of the retrospective nature.
Methodology: retrospective, diagnostic /observational study, performed at one institution.