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Transition from BOS to RAS impairs prognosis after lung transplantation-CLAD subtype analysis by CT volumetry
Laura Peräkylä1, Antti Nykänen1, Anneli Piilonen2
1Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Plos One
|October 12, 2022
Summary
A small fraction of lung transplant recipients with bronchiolitis obliterans syndrome (BOS) transition to restrictive allograft syndrome (RAS). This transition, identified by CT volumetry, significantly reduces survival for both recipients and their grafts.
Area of Science:
- Pulmonary Medicine
- Transplantation Immunology
- Radiology
Background:
- Chronic lung allograft dysfunction (CLAD) is a major limitation in lung transplant survival.
- CLAD is subclassified into bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS).
- Limited information exists regarding the transition from BOS to RAS.
Purpose of the Study:
- To characterize lung volume changes after BOS diagnosis using CT volumetry.
- To determine the incidence, risk factors, and clinical significance of BOS to RAS transition.
Main Methods:
- CT volumetry was used to assess lung volumes in 63 CLAD patients initially diagnosed with BOS.
- Patients were classified as persistent BOS (>85% baseline lung volume) or BOS to RAS transition (≤85% baseline lung volume).
Main Results:
- Eight patients (12.7%) transitioned from BOS to RAS during a median 9.8-year follow-up.
- BOS to RAS transition was associated with decreased recipient and graft survival (p = 0.004 and p = 0.020, respectively).
- Opacities on chest imaging at BOS diagnosis and early CLAD diagnosis were identified as risk factors for transition.
Conclusions:
- A small proportion of BOS patients transition to RAS, as indicated by lung volume decrease via CT volumetry.
- This transition negatively impacts recipient and graft survival following lung transplantation.
