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Multiple breath washout in pediatric patients after lung transplantation


Nyilas, S; Carlens, J; Price, T; Singer, F; Müller, C; Hansen, G; Warnecke, G; Latzin, P; Schwerk, N (2018). Multiple breath washout in pediatric patients after lung transplantation. American Journal of Transplantation, 18(1):145-153.

Abstract

Forced expiratory volume in 1 second (FEV ) from spirometry is the most commonly used parameter to detect early allograft dysfunction after lung transplantation (LTx). There are concerns regarding its sensitivity. Nitrogen-multiple breath washout (N -MBW) is sensitive at detecting early global (lung clearance index [LCI]) and acinar (S ) airway inhomogeneity. We investigated whether N -MBW indices indicate small airways pathology after LTx in children with stable spirometry. Thirty-seven children without bronchiolitis obliterans syndrome [BOS] at a median of 1.6 (0.6-3.0) years after LTx underwent N -MBW and spirometry, 28 of those on 2 occasions (≤6 months apart) during clinically stable periods. Additional longitudinal data (11 and 8 measurements, respectively) are provided from 2 patients with BOS. In patients without BOS, LCI and S were significantly elevated compared with healthy controls. LCI was abnormal at the 2 test occasions in 81% and 71% of patients, respectively, compared with 30% and 39% of patients with abnormal FEV /forced vital capacity (FVC). Correlations of LCI with FEV /FVC (r = 0.1, P = .4) and FEV (r = -0.1, P = .6) were poor. N -MBW represents a sensitive and reproducible tool for the early detection of airways pathology in stable transplant recipients. Moreover, indices were highly elevated in both patients with BOS. Spirometry and LCI showed poor correlation, indicating distinct and complementary physiologic measures.

Abstract

Forced expiratory volume in 1 second (FEV ) from spirometry is the most commonly used parameter to detect early allograft dysfunction after lung transplantation (LTx). There are concerns regarding its sensitivity. Nitrogen-multiple breath washout (N -MBW) is sensitive at detecting early global (lung clearance index [LCI]) and acinar (S ) airway inhomogeneity. We investigated whether N -MBW indices indicate small airways pathology after LTx in children with stable spirometry. Thirty-seven children without bronchiolitis obliterans syndrome [BOS] at a median of 1.6 (0.6-3.0) years after LTx underwent N -MBW and spirometry, 28 of those on 2 occasions (≤6 months apart) during clinically stable periods. Additional longitudinal data (11 and 8 measurements, respectively) are provided from 2 patients with BOS. In patients without BOS, LCI and S were significantly elevated compared with healthy controls. LCI was abnormal at the 2 test occasions in 81% and 71% of patients, respectively, compared with 30% and 39% of patients with abnormal FEV /forced vital capacity (FVC). Correlations of LCI with FEV /FVC (r = 0.1, P = .4) and FEV (r = -0.1, P = .6) were poor. N -MBW represents a sensitive and reproducible tool for the early detection of airways pathology in stable transplant recipients. Moreover, indices were highly elevated in both patients with BOS. Spirometry and LCI showed poor correlation, indicating distinct and complementary physiologic measures.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Children's Hospital Zurich > Medical Clinic
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Immunology and Allergy
Health Sciences > Transplantation
Health Sciences > Pharmacology (medical)
Language:English
Date:January 2018
Deposited On:07 Dec 2018 09:22
Last Modified:29 Jul 2020 08:18
Publisher:Wiley-Blackwell Publishing, Inc.
ISSN:1600-6135
OA Status:Closed
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1111/ajt.14432
PubMed ID:28719135

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