Atelectasis in primary graft dysfunction survivors after lung transplantation

Area of Science:

• Transplantation Medicine
• Radiology
• Pulmonary Medicine

Background:

• Primary graft dysfunction (PGD) significantly impacts early mortality and lung function post-lung transplant.
• Radiographic findings of PGD on computed tomography (CT) have not been well-characterized.

Purpose of the Study:

• To characterize the radiographic sequelae of PGD on 3-month post-transplant CT scans.
• To investigate the relationship between PGD, CT findings, and subsequent lung function and allograft dysfunction.

Main Methods:

• Adult double lung transplant recipients (2010-2016) with available 3-month protocol CT scans were analyzed.
• CT scans were assessed for various findings including effusions, ground glass, atelectasis, nodularity, consolidation, septal thickening, air trapping, and fibrosis.
• The association between PGD, CT findings, lung function (FEV1), baseline lung allograft dysfunction (BLAD), and chronic lung allograft dysfunction (CLAD) was examined.

Main Results:

• Of 237 patients, 50 (21%) experienced grade 3 PGD (PGD3).
• PGD3 was associated with increased interlobular septal thickening and atelectasis at 3 months.
• Only atelectasis remained significantly associated with PGD3 after multiple testing correction and was linked to lower FEV1 and increased BLAD risk.

Conclusions:

• Severe PGD in lung transplant recipients is associated with atelectasis observed on 3-month post-transplant CT scans.
• Atelectasis on routine CT may serve as an identifiable intermediate marker linking PGD to poorer future lung function.