LUNG TRANSPLANTATION

Bronchiolitis obliterans following lung transplantation: early detection using computed tomographic scanning

P A de Jong^1,2,3,4,5, J D Dodd², H O Coxson^2,4, C Storness-Bliss^1,2, P D Paré^1,4, J R Mayo², R D Levy^1,3,4

¹ Department of Medicine, University of British Columbia, Vancouver, BC, Canada
² Department of Radiology, University of British Columbia, Vancouver, BC, Canada
³ Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands
⁴ James Hogg iCAPTURE Centre for Cardiovascular and Pulmonary Research, Vancouver, BC, Canada
⁵ British Columbia Transplant Society, Vancouver, BC, Canada

Correspondence to:
Dr R D Levy
BC Transplant Society, 3rd Floor, West Tower, 555 West 12th Avenue, Vancouver, BC, Canada V5Z 3X7; rlevy{at}providencehealth.bc.ca

Background: Computed tomographic (CT) scanning may enable earlier diagnosis of chronic lung allograft dysfunction than forced expiratory volume in 1 second (FEV₁). A study was undertaken to determine intra-observer and inter-observer agreement of composite and air trapping CT scores, to examine the association of FEV₁ with the composite and air trapping CT score, and to relate the baseline composite CT score to changes in FEV₁ and changes in the composite CT score over 1 year.

Methods: Lung function and baseline CT scans following transplantation and at subsequent annual follow ups were analysed in 38 lung transplant recipients. Scans were randomly scored by two observers for bronchiectasis, mucus plugging, airway wall thickening, consolidation, mosaic pattern, and air trapping, and re-scored after 1 month. CT scores were expressed on a scale of 0–100 and correlated with FEV₁ as a percentage of the post-transplant baseline value.

Results: The mean (SD) interval between baseline and follow up CT scans was 11.2 (4.7) months. Inter-observer and intra-observer agreement was good for both the composite and air trapping CT scores. There was a significant association between FEV₁ and the composite CT score, with each unit of worsening in the baseline composite CT score predicting a 1.55% and 1.37% worsening in FEV₁ over the following year (p<0.0001) and a 1.25 and 1.12 unit worsening in the composite CT score (p<0.0001) for observers 1 and 2, respectively.

Conclusion: These findings indicate a potential role for a composite CT scoring system in the early detection of bronchiolitis obliterans.

Abbreviations: BO, bronchiolitis obliterans; BOS, bronchiolitis obliterans syndrome; CT, computed tomography; FEV₁, forced expiratory volume in 1 second

Keywords: computed tomography; lung function; bronchiolitis obliterans; lung transplantation

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