ABSTRACT
Chronic lung allograft dysfunction (CLAD) remains the leading cause of mortality in lung transplant recipients after the first year. Treatment remains limited and unpredictable. Existing data suggests extracorporeal photopheresis (ECP) may be beneficial. This study aimed to identify factors predicting treatment response and the prognostic implications. A single center retrospective analysis of all patients commencing ECP for CLAD between November 1, 2007 and September 1, 2011 was performed. In total 65 patients were included, 64 of whom had deteriorated under azithromycin. Median follow-up after commencing ECP was 503 days. Upon commencing ECP, all patients were classified using proposed criteria for emerging clinical phenotypes, including "restrictive allograft syndrome (RAS)", "neutrophilic CLAD (nCLAD)" and "rapid decliners". At follow-up, 8 patients demonstrated ≥10% improvement in FEV1 , 27 patients had stabilized and 30 patients exhibited ≥10% decline in FEV1 . Patients fulfilling criteria for "rapid decliners" (n=21, p=0.005), RAS (n=22, p=0.002) and those not exhibiting neutrophilia in bronchoalveolar lavage (n=44, p=0.01) exhibited poorer outcomes. ECP appears an effective second line treatment in CLAD patients progressing under azithromycin. ECP responders demonstrated improved progression-free survival (median 401 vs. 133 days). Proposed CLAD phenotypes require refinement, but appear to predict the likelihood of ECP response.
Subject(s)
Lung Transplantation/methods , Photopheresis , Primary Graft Dysfunction/prevention & control , Adult , Algorithms , Anti-Bacterial Agents/pharmacology , Azithromycin/pharmacology , Bronchiolitis Obliterans/physiopathology , Bronchiolitis Obliterans/therapy , Bronchoalveolar Lavage , Disease-Free Survival , Female , Forced Expiratory Volume , Humans , Light , Lung/physiopathology , Male , Middle Aged , Neutrophils/metabolism , Phenotype , Primary Graft Dysfunction/physiopathology , Retrospective Studies , Transplantation, Homologous , Treatment OutcomeABSTRACT
Bronchial wall thickness measurements in computed tomography (CT) has become a useful tool for assessment of the severity of diseaseand the response to treatment in a large number of pulmonary diseases. However, there are only few reports evaluating its dependence on different scan protocols. The effect of intravenous contrast medium has not been analyzed. The aim of this study was to evaluate the influence of intravenous contrast medium application, the contrast phase (arterial and venous) and different reconstruction kernels on bronchial wall measurements of a newly developed algorithm. The bronchial wall thickness was analyzed in 630 bronchial sections of 56 CT examinations with dedicated software (MEVIS Airway Examiner, Fraunhofer MEVIS Bremen, Germany). Application of i.v. contrast agent significantly increased bronchial wall thickness (paired t-test, p<0.001). Comparing arterial and venous phase, bronchial wall thickness was significant higher in the arterial phase (paired t-test, p=0.045). Bronchial wall thickness also increased (ANOVA with Bonferroni correction, p<0.001) when using a softer reconstruction kernel. The absolute differences in bronchial wall thickness were independent of bronchial size and generation.
Subject(s)
Algorithms , Bronchography/methods , Imaging, Three-Dimensional/methods , Radiographic Image Enhancement/methods , Radiographic Image Interpretation, Computer-Assisted/methods , Tomography, X-Ray Computed/methods , Adult , Aged , Aged, 80 and over , Contrast Media/administration & dosage , Female , Humans , Injections, Intravenous , Male , Middle Aged , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
The Rivermead Behavioural Memory Test provides a well-validated instrument for detecting everyday memory problems in patient groups. It was however designed as a screening test, and thus is insufficiently sensitive to detect mild deficits, whether due to brain damage or to the introduction of a drug or stressor. The Extended Rivermead Behavioural Memory Test (ERBMT) increases the level of difficulty by doubling the amount of material to be remembered, by combining material from Forms A and B, and Forms C and D of the original test to produce two parallel versions of the new extended test. The sensitivity of the ERBMT was assessed by comparing the performance of a middle-aged and an elderly group of normal subjects, who would be expected to show modest differences in memory performance. The subtests varied in their sensitivity to this small age difference, but when performance was assessed in terms of scaled scores that allow an overall combined measure of memory performance to be calculated, the test proved sensitive (t = 4.87, P < 0.0001), and free of ceiling and floor effects. We suggest that the ERBMT provides a promising measure of everyday memory in normal adults.