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Quantitative CT Imaging Analysis for Chronic Lung Allograft Dysfunction in Single Lung Transplant Recipients
Abstracts to cause alveolar epithelial apoptosis resulting in lung emphysema in patients with chronic obstructive pulmonary disease. Similar to the patients with emphysema, the patients with chronic lung allograft dysfunction (CLAD) after living-donor lobar lung transplantation (LDLLT) could show emphysematous changes, because in LDLLT, small lobar grafts expand to fit into the recipient’s chest cavity due to the size mismatch. However, the relationship between serum irisin levels and CLAD after LDLLT remains unknown. Methods: Blood samples were collected from a total of 33 patients who underwent bilateral LDLLT, including patients with CLAD (the CLAD group, n=11) and those without CLAD (the non-CLAD group, n=22). Serum samples were assayed for irisin using ELISA kit and compared between the two groups. Appropriate cut-off values of irisin level were set for the diagnosis of CLAD. Results: The median follow-up period was 4366 (1055-7180) days. Serum irisin levels of the CLAD group were significantly lower than those of the non-CLAD group (9.5 § 3.4 vs. 13.2 § 4.2 ng/mL, P = 0.018) (Fig. 1). An ROC analysis of the performance of the serum irisin level as a marker of CLAD yielded an AUC of 0.76 (sensitivity=0.91 and specificity=0.64 at a threshold level of 12.6 ng/mL). Moreover, patients with irisin level ≥12.6 ng/mL (n=16) showed significantly better CLAD-free survival than those with irisin level <12.6 ng/mL (n=17) (P=0.001) (Fig. 2). Conclusion: Decreased serum irisin levels are associated with the development of CLAD after bilateral LDLLT. Irisin might be a novel biomarker for the diagnosis of CLAD after LDLLT.
S407 1027 Quantitative CT Imaging Analysis for Chronic Lung Allograft Dysfunction in Single Lung Transplant Recipients M. Horie,1 T. Saito,1 L. Levy,1 P. Salazar,2 C. Houbois,1 S. Keshavjee,1 N. Paul,3 and T. Martinu.1 1Toronto Lung Transplant Program, Toronto, ON, Canada; 2Vital Images, Minnetonka, MN; and the 3Department of Medical Imaging, London Health Sciences, London, United Kingdom. Purpose: Chronic lung allograft dysfunction (CLAD) limits long term survival after lung transplantation (LTx). Distinction of CLAD subtypes relies on total lung capaciy (TLC) testing which is more cumbersome and less frequently performed compared to FEV1. Also, diagnosing CLAD is more difficult in single compared to double LTx patients due to the contribution of both the native lung and the allograft to FEV1 changes. CT can evaluate the lungs individually and could represent an alternative to TLC testing. Our aim was to investigate the utility of quantitative CT (QCT) in CLAD single LTx patients. Methods: Of 138 patients who underwent single LTx 2006-2014, 35 (16 right, 19 left) developed CLAD, were followed for at least 1 year after CLAD onset, and had CT scans at baseline and at CLAD onset. CT lung volume (total volume of both native and allograft lungs) was compared with TLC values. The area under the ROC curve (AUC) was used to compare patients with shorter survial (< 1 year) to those with longer survival (≥ 1 year) after CLAD onset using QCT analysis of allograft lung: volume as a % of baseline, functional principal component analysis (FPCA) using hounsfield units (HU) density histogram at CLAD onset, mean HU at CLAD onset, and HU as a % of baseline. FPCA is a statistical approach that was used for dimension reduction of HU density histogram from QCT data. Results: 31 patients had TLC at baseline and 29 at CLAD onset. CT volumes were highly correlated with TLC at both time points (p < 0.0001). Average FEV1(% of baseline) for shorter survival patients (n=12) and longer survival patients (n=23) was similar (74§5%, 75§5%, p=0.67). AUC for differentiating between the 2 groups using QCT on the allograft lung were FPCA = 0.69[95% CI0.51-0.83], p=0.047, mean HU = 0.67[0.500.82], p=0.11, volume (% of baseline) = 0.64[0.46-0.80], p=0.24, and HU (% of baseline) = 0.61[0.43-0.77], p=0.33. Conclusion: QCT may be a useful radiologic tool for discriminating CLAD prognosis not only for double LTx but also for single LTx.
1028 Phenotypical Diversity of Airway Pathology in Chronic Pulmonary GvHD after Hematopoietic Stem Cell Transplantation S.E. Verleden,1 J. Mcdonough,1 H. Schoemans,1 C. Knoop,2 J. Verschakelen,1 A. Dubbeldam,1 M. Boone,3 L. Van Hoorebeke,4 E. Verbeken,1 B. Weynand,1 D. Van Raemdonck,1 G. Verleden,1 R. Vos,1 and B. Vanaudenaerde.1 1KU Leuven, Leuven, Belgium; 2University of Brussels, Brussel, Belgium; 3University of Ghent, Gent, Belgium; and the 4 University of Ghent, Ghent, Belgium. Purpose: Chronic pulmonary graft versus host disease (cpGvHD) is a diverse and underestimated complication following allogenic hematopoietic stem cell transplantation (alloHCT). We aimed to compare the airway architecture with chronic lung allograft dysfunction (CLAD) after lung transplantation (LTx).
S407 1027 Quantitative CT Imaging Analysis for Chronic Lung Allograft Dysfunction in Single Lung Transplant Recipients M. Horie,1 T. Saito,1 L. Levy,1 P. Salazar,2 C. Houbois,1 S. Keshavjee,1 N. Paul,3 and T. Martinu.1 1Toronto Lung Transplant Program, Toronto, ON, Canada; 2Vital Images, Minnetonka, MN; and the 3Department of Medical Imaging, London Health Sciences, London, United Kingdom. Purpose: Chronic lung allograft dysfunction (CLAD) limits long term survival after lung transplantation (LTx). Distinction of CLAD subtypes relies on total lung capaciy (TLC) testing which is more cumbersome and less frequently performed compared to FEV1. Also, diagnosing CLAD is more difficult in single compared to double LTx patients due to the contribution of both the native lung and the allograft to FEV1 changes. CT can evaluate the lungs individually and could represent an alternative to TLC testing. Our aim was to investigate the utility of quantitative CT (QCT) in CLAD single LTx patients. Methods: Of 138 patients who underwent single LTx 2006-2014, 35 (16 right, 19 left) developed CLAD, were followed for at least 1 year after CLAD onset, and had CT scans at baseline and at CLAD onset. CT lung volume (total volume of both native and allograft lungs) was compared with TLC values. The area under the ROC curve (AUC) was used to compare patients with shorter survial (< 1 year) to those with longer survival (≥ 1 year) after CLAD onset using QCT analysis of allograft lung: volume as a % of baseline, functional principal component analysis (FPCA) using hounsfield units (HU) density histogram at CLAD onset, mean HU at CLAD onset, and HU as a % of baseline. FPCA is a statistical approach that was used for dimension reduction of HU density histogram from QCT data. Results: 31 patients had TLC at baseline and 29 at CLAD onset. CT volumes were highly correlated with TLC at both time points (p < 0.0001). Average FEV1(% of baseline) for shorter survival patients (n=12) and longer survival patients (n=23) was similar (74§5%, 75§5%, p=0.67). AUC for differentiating between the 2 groups using QCT on the allograft lung were FPCA = 0.69[95% CI0.51-0.83], p=0.047, mean HU = 0.67[0.500.82], p=0.11, volume (% of baseline) = 0.64[0.46-0.80], p=0.24, and HU (% of baseline) = 0.61[0.43-0.77], p=0.33. Conclusion: QCT may be a useful radiologic tool for discriminating CLAD prognosis not only for double LTx but also for single LTx.
1028 Phenotypical Diversity of Airway Pathology in Chronic Pulmonary GvHD after Hematopoietic Stem Cell Transplantation S.E. Verleden,1 J. Mcdonough,1 H. Schoemans,1 C. Knoop,2 J. Verschakelen,1 A. Dubbeldam,1 M. Boone,3 L. Van Hoorebeke,4 E. Verbeken,1 B. Weynand,1 D. Van Raemdonck,1 G. Verleden,1 R. Vos,1 and B. Vanaudenaerde.1 1KU Leuven, Leuven, Belgium; 2University of Brussels, Brussel, Belgium; 3University of Ghent, Gent, Belgium; and the 4 University of Ghent, Ghent, Belgium. Purpose: Chronic pulmonary graft versus host disease (cpGvHD) is a diverse and underestimated complication following allogenic hematopoietic stem cell transplantation (alloHCT). We aimed to compare the airway architecture with chronic lung allograft dysfunction (CLAD) after lung transplantation (LTx).