Mismatched perfusion defects on routine ventilation-perfusion scans after lung transplantation.
chronic
diagnostic techniques and imaging
lung (allograft) function/dysfunction
rejection
thrombosis and thromboembolism
Journal
Clinical transplantation
ISSN: 1399-0012
Titre abrégé: Clin Transplant
Pays: Denmark
ID NLM: 8710240
Informations de publication
Date de publication:
06 2022
06 2022
Historique:
revised:
08
03
2022
received:
16
12
2021
accepted:
09
03
2022
pubmed:
16
3
2022
medline:
16
6
2022
entrez:
15
3
2022
Statut:
ppublish
Résumé
Incidental pulmonary embolism (PE) is a challenging entity with unclear treatment implications. Our program performs routine ventilation-perfusion (VQ) scans at 3-months post-transplant to establish airway and vascular function. We sought to determine the prevalence and prognostic implications of mismatched perfusion defects (MMPD) found on these studies, hypothesizing they would be associated with a benign prognosis. We studied VQ scans obtained routinely at 3-months post-transplant from double lung transplant recipients 2005-2016 for studies with MMPD interpreted as high or intermediate probability for PE. We tested the relationship between MMPD and 1-year survival via chi square testing, overall survival via Kaplan Meier analysis with log rank testing and peak forced expiratory volume in 1 second (FEV1) percent predicted via t-testing. Three hundred and seventy-three patients met inclusion criteria, of whom 35 (9%) had VQ scans with MMPDs interpreted by radiologists as high or intermediate probability for PE. Baseline recipient and donor characteristics were similar between groups. Seven patients (20%) in the MMPD group were treated with therapeutic anticoagulation. Patients with MMPD had similar 1-year survival (100% vs. 98%, P = 1.00), overall survival (log rank P = .90) and peak FEV1% predicted (94% [SD 20%] vs. 92% [SD 21%]; P = .58). Anticoagulation did not affect these relationships. Mismatched perfusion defects on routine post-transplant VQ scan were not associated with a difference in survival or lung function. A conservative approach to these changes may be a viable option in the absence of other anticoagulation indications.
Sections du résumé
BACKGROUND
Incidental pulmonary embolism (PE) is a challenging entity with unclear treatment implications. Our program performs routine ventilation-perfusion (VQ) scans at 3-months post-transplant to establish airway and vascular function. We sought to determine the prevalence and prognostic implications of mismatched perfusion defects (MMPD) found on these studies, hypothesizing they would be associated with a benign prognosis.
METHODS
We studied VQ scans obtained routinely at 3-months post-transplant from double lung transplant recipients 2005-2016 for studies with MMPD interpreted as high or intermediate probability for PE. We tested the relationship between MMPD and 1-year survival via chi square testing, overall survival via Kaplan Meier analysis with log rank testing and peak forced expiratory volume in 1 second (FEV1) percent predicted via t-testing.
RESULTS
Three hundred and seventy-three patients met inclusion criteria, of whom 35 (9%) had VQ scans with MMPDs interpreted by radiologists as high or intermediate probability for PE. Baseline recipient and donor characteristics were similar between groups. Seven patients (20%) in the MMPD group were treated with therapeutic anticoagulation. Patients with MMPD had similar 1-year survival (100% vs. 98%, P = 1.00), overall survival (log rank P = .90) and peak FEV1% predicted (94% [SD 20%] vs. 92% [SD 21%]; P = .58). Anticoagulation did not affect these relationships.
CONCLUSION
Mismatched perfusion defects on routine post-transplant VQ scan were not associated with a difference in survival or lung function. A conservative approach to these changes may be a viable option in the absence of other anticoagulation indications.
Substances chimiques
Anticoagulants
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14650Subventions
Organisme : CIHR
Pays : Canada
Informations de copyright
© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Heart J. 2019;41(4):543-603.
Bajc M, Neilly JB, Miniati M, et al. EANM guidelines for ventilation/perfusion scintigraphy. Eur J Nucl Med Mol I. 2009;36(8):1356-1370.
Minet C, Lugosi M, Savoye PY, et al. Pulmonary embolism in mechanically ventilated patients requiring computed tomography: Prevalence, risk factors, and outcome*. Crit Care Med. 2012;40(12):3202-3208.
Sommer W, Kirschner H, Ius F, et al. Transplantation of donor lungs with pulmonary embolism - a retrospective study. Transplant Int. 2019;32(6):658-667.
Oto T, Rabinov M, Griffiths AP, et al. Unexpected donor pulmonary embolism affects early outcomes after lung transplantation: A major mechanism of primary graft failure? J Thorac Cardiovasc Surg. 2005;130(5):1446.e1-1446.e9.
Terada Y, Gauthier JM, Pasque MK, et al. Clinical outcomes of lung transplants from donors with unexpected pulmonary embolism. Ann Thorac Surg.
Ferraro P, Martin J, Dery J, et al. Late retrograde perfusion of donor lungs does not decrease the severity of primary graft dysfunction. Ann Thorac Surg. 2008;86(4):1123-1129.
Izbicki G, Bairey O, Shitrit D, Lahav J, Kramer MR. Increased thromboembolic events after lung transplantation. Chest. 2006;129(2):412-416.
Kroshus TJ, Kshettry VR, Hertz MI, Bolman RM. Deep venous thrombosis and pulmonary embolism after lung transplantation. J Thorac Cardiovasc Surg. 1995;110(2):540-544.
Bhatia KD, Ambati C, Dhaliwal R, et al. SPECT-CT/VQ versus CTPA for diagnosing pulmonary embolus and other lung pathology: pre-existing lung disease should not be a contraindication. J Med Imag Radiat On. 2016;60(4):492-497.
Leblanc M, Paul N. V/Q SPECT and computed tomographic pulmonary angiography. Semin Nucl Med. 2010;40(6):426-441.
Freeman LM. Don't bury the V/Q scan: it's as good as multidetector CT angiograms with a lot less radiation exposure. J Nucl Med. 2008;49(1):5-8.
Sostman HD, Stein PD, Gottschalk A, Matta F, Hull R, Goodman L. Acute pulmonary embolism: sensitivity and specificity of ventilation-perfusion scintigraphy in PIOPED II study. Radiology. 2008;246(3):941-946.
Cronin P, Dwamena BA. A clinically meaningful interpretation of the prospective investigation of pulmonary embolism diagnosis (PIOPED) scintigraphic data. Acad Radiol. 2017;24(5):550-562.
Verleden GM, Glanville AR, Lease ED, et al. Chronic lung allograft dysfunction: definition, diagnostic criteria and approaches to treatment. A consensus report from the pulmonary council of the ISHLT. J Heart Lung Transplant. 2019;1-44.
Liu J, Jackson K, Weinkauf J, et al. Baseline lung allograft dysfunction is associated with impaired survival after double-lung transplantation. J Heart Lung Transplant Official Publ Int Soc Heart Transplant. 2018;37(7):895-902.
Snell GI, Yusen RD, Weill D, et al. Report of the ISHLT Working Group on Primary Lung Graft Dysfunction, part I: Definition and grading-a 2016 Consensus group statement of the international society for heart and lung transplantation. J Heart Lung Transplant. 2017;36(10):1097-1103.
Oto T, Excell L, Griffiths AP, Levvey BJ, Snell GI. The implications of pulmonary embolism in a multiorgan donor for subsequent pulmonary, renal, and cardiac transplantation. J Heart Lung Transplant. 2008;27(1):78-85.
Aboagye JK, Hayanga JWA, Lau BD, et al. Venous thromboembolism in patients hospitalized for lung transplantation. Ann Thorac Surg. 2018;105(4):1071-1076.
Siddique A, Bose AK, Özalp F, et al. Vascular anastomotic complications in lung transplantation: a single institution's experience. Interact Cardiov Th. 2013;17(4):625-631.
Uhlmann EJ, Dunitz JM, Fiol ME. Pulmonary vein thrombosis after lung transplantation presenting as stroke. J Heart Lung Transplant. 2009;28(2):209-210.
Agnelli G, Becattini C, Kirschstein T. Thrombolysis vs heparin in the treatment of pulmonary embolism: a clinical outcome-based meta-analysis. Arch Intern Med. 2002;162(22):2537-2541.
Kosova E, Bergmark B, Piazza G. Fat embolism syndrome. Circulation. 2015;131(3):317-320.
Jacob S, Courtwright A, El-Chemaly S, et al. Donor-acquired fat embolism syndrome after lung transplantation. Eur J Cardio-thorac. 2016;49(5):1344-1347.
Batra K, Chamarthy MR, Reddick M, Roda MS, Wait M, Kalva SP. Diagnosis and interventions of vascular complications in lung transplant. Cardiovasc Diagnosis Ther. 2018;8(3):378-386.
Nemec SF, Bankier AA, Eisenberg RL. Lower lobe-predominant diseases of the lung. Am J Roentgenol. 2013;200(4):712-728.
Goldhaber SZ, Visani L, Rosa MD, ICOPER for. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet. 1999;353(9162):1386-1389.
Fukushi K, Kataoka M, Shimura N, et al. Impaired respiratory function in chronic thromboembolic pulmonary hypertension: a comparative study with healthy control subjects. Ann Am Thorac Soc. 2016;13(7):1183-1184.
Pengo V, Lensing AWA, Prins MH, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. New Engl J Medicine. 2004;350(22):2257-2264.
Krishnam MS, Suh RD, Tomasian A, et al. Postoperative complications of lung transplantation: radiologic findings along a time continuum. Radiographics. 2007;27(4):957-974.
Cueto SM, Cavanaugh SH, Benenson RS, Redclift MS. Computed tomography scan versus ventilation-perfusion lung scan in the detection of pulmonary embolism. J Emerg Med. 2001;21(2):155-164.