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Restrictive allograft syndrome after lung transplantation: new radiological insights

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Abstract

Objectives

To describe the CT changes in patients with restrictive allograft syndrome (RAS) after lung transplantation, before and after clinical diagnosis.

Methods

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.

Results

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).

Conclusions

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.

Key points

• 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.

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Abbreviations

RAS:

Restrictive allograft syndrome

CLAD:

Chronic lung allograft dysfunction

BOS:

Bronchiolitis obliterans syndrome

NRAD:

Neutrophilic reversible allograft dysfunction

ARAD:

Azithromycin reversible allograft dysfunction

CT:

Computed tomography

HRCT:

High-resolution CT

FEV1:

Forced expiratory volume in 1 second

TLC:

Total lung capacity

PFT:

Pulmonary function testing

PPFE:

Pleuroparenchymal fibroelastosis

AFOP:

Acute fibrinoid organizing pneumonia

PACS:

Picture archiving and communication system

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Acknowledgments

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.

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Authors and Affiliations

  1. Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    Adriana Dubbeldam, Caroline Barthels, Johan Coolen, Johny A. Verschakelen & Walter De Wever

  2. Department of Pneumology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    Stijn E. Verleden, Robin Vos & Geert M. Verleden

Authors
  1. Adriana Dubbeldam
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  2. Caroline Barthels
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  3. Johan Coolen
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  4. Johny A. Verschakelen
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  5. Stijn E. Verleden
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  6. Robin Vos
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  7. Geert M. Verleden
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  8. Walter De Wever
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Corresponding author

Correspondence to Adriana Dubbeldam.

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Dubbeldam, A., Barthels, C., Coolen, J. et al. Restrictive allograft syndrome after lung transplantation: new radiological insights. Eur Radiol 27, 2810–2817 (2017). https://doi.org/10.1007/s00330-016-4643-5

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  • DOI: https://doi.org/10.1007/s00330-016-4643-5

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