Inflammation and primary graft dysfunction after lung transplantation: CT-PET findings

Miriam Gotti; Davide Chiumello; Massimo Cressoni; Mariateresa Guanziroli; Matteo Brioni; Bijan Safaee Fakhr; Chiara Chiurazzi; Andrea Colombo; Dario Massari; Ilaria Algieri; Caterina Lonati; Paolo Cadringher; Paolo Taccone; Marta Pizzocri; Jacopo Fumagalli; Lorenzo Rosso; Alessandro Palleschi; Riccardo Benti; Felicia Zito; Franco Valenza; Luciano Gattinoni

doi:10.23736/S0375-9393.18.12651-4

Inflammation and primary graft dysfunction after lung transplantation: CT-PET findings

Miriam Gotti, Davide Chiumello, Massimo Cressoni, Mariateresa Guanziroli, Matteo Brioni, Bijan Safaee Fakhr, Chiara Chiurazzi, Andrea Colombo, Dario Massari, Ilaria Algieri, Caterina Lonati, Paolo Cadringher, Paolo Taccone, Marta Pizzocri, Jacopo Fumagalli, Lorenzo Rosso, Alessandro Palleschi, Riccardo Benti, Felicia Zito, Franco ValenzaLuciano Gattinoni

Fondazione IRCCS Ca' Granda- Ospedale Maggiore Policlinico

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: The leading cause of early mortality after lung transplantation is Primary graft dysfunction (PGD). We assessed the lung inflammation, inflation status and inhomogeneities after lung transplantation. Our purpose was to investigate the possible differences between patients who did or did not develop PGD.

METHODS: We designed a prospective observational study enrolling patients who underwent a CT-PET study within 1 week after lung transplantation. Twenty-four patients (10 after double- and 14 after single-lung) were enrolled. Respiratory and hemodynamic data were collected before, during and after lung transplantation. Each patient underwent computed tomography-positron emission tomography (CT-PET) scan early after surgery. Broncho-alveolar lavage (BAL) fluid collection was performed to analyze inflammatory mediators.

RESULTS: The grafts showed a [18F]fluoro-2-deoxy-D-glucose ([18F]FDG) uptake rate of 26[18-33]*10-4 mLblood/mLtissue/min (reference values 11[7-15]*10-4). Three double- and six single-lung recipients developed PGD. The grafts of patients who developed PGD had similar [18F]FDG uptake than grafts of patients who did not (28[18-26]*10-4 versus 26[22-31]*10-4, P=0.79). Not-inflated tissue fraction was significantly higher (28[20-38]% versus 14[7-21]%, P=0.01) while well-inflated fraction was significantly lower (29[25-41]% versus 53[39-65]%, P<0.01). Inhomogeneity extent was higher in patients who developed PGD (23[18-26]% versus 14[10-20]%, P=0.01)The lung weight was 650[591-820]g versus 597[480-650]g (P=0.09)). BAL fluid analysis for inflammatory mediators did not detect a difference between the study groups.

CONCLUSIONS: Compared to healthy lungs, all the grafts showed increased [18F]FDG uptake rate, but there were no differences between patients who developed PGD and patients who did not. Of note, the PGD patients showed a worse inflation status of lungs and a higher inhomogeneity extent.

Original language	English
Pages (from-to)	1169-1177
Number of pages	9
Journal	Minerva Anestesiologica
Volume	84
Issue number	10
DOIs	https://doi.org/10.23736/S0375-9393.18.12651-4
Publication status	Published - Oct 1 2018

ASJC Scopus subject areas

Anesthesiology and Pain Medicine

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10.23736/S0375-9393.18.12651-4

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Gotti, M., Chiumello, D., Cressoni, M., Guanziroli, M., Brioni, M., Safaee Fakhr, B., Chiurazzi, C., Colombo, A., Massari, D., Algieri, I., Lonati, C., Cadringher, P., Taccone, P., Pizzocri, M., Fumagalli, J., Rosso, L., Palleschi, A., Benti, R., Zito, F., ... Gattinoni, L. (2018). Inflammation and primary graft dysfunction after lung transplantation: CT-PET findings. Minerva Anestesiologica, 84(10), 1169-1177. https://doi.org/10.23736/S0375-9393.18.12651-4

Gotti, M, Chiumello, D, Cressoni, M, Guanziroli, M, Brioni, M, Safaee Fakhr, B, Chiurazzi, C, Colombo, A, Massari, D, Algieri, I, Lonati, C, Cadringher, P, Taccone, P, Pizzocri, M, Fumagalli, J, Rosso, L , Palleschi, A , Benti, R , Zito, F, Valenza, F & Gattinoni, L 2018, 'Inflammation and primary graft dysfunction after lung transplantation: CT-PET findings', Minerva Anestesiologica, vol. 84, no. 10, pp. 1169-1177. https://doi.org/10.23736/S0375-9393.18.12651-4

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title = "Inflammation and primary graft dysfunction after lung transplantation: CT-PET findings",

abstract = "BACKGROUND: The leading cause of early mortality after lung transplantation is Primary graft dysfunction (PGD). We assessed the lung inflammation, inflation status and inhomogeneities after lung transplantation. Our purpose was to investigate the possible differences between patients who did or did not develop PGD.METHODS: We designed a prospective observational study enrolling patients who underwent a CT-PET study within 1 week after lung transplantation. Twenty-four patients (10 after double- and 14 after single-lung) were enrolled. Respiratory and hemodynamic data were collected before, during and after lung transplantation. Each patient underwent computed tomography-positron emission tomography (CT-PET) scan early after surgery. Broncho-alveolar lavage (BAL) fluid collection was performed to analyze inflammatory mediators.RESULTS: The grafts showed a [18F]fluoro-2-deoxy-D-glucose ([18F]FDG) uptake rate of 26[18-33]*10-4 mLblood/mLtissue/min (reference values 11[7-15]*10-4). Three double- and six single-lung recipients developed PGD. The grafts of patients who developed PGD had similar [18F]FDG uptake than grafts of patients who did not (28[18-26]*10-4 versus 26[22-31]*10-4, P=0.79). Not-inflated tissue fraction was significantly higher (28[20-38]% versus 14[7-21]%, P=0.01) while well-inflated fraction was significantly lower (29[25-41]% versus 53[39-65]%, P<0.01). Inhomogeneity extent was higher in patients who developed PGD (23[18-26]% versus 14[10-20]%, P=0.01)The lung weight was 650[591-820]g versus 597[480-650]g (P=0.09)). BAL fluid analysis for inflammatory mediators did not detect a difference between the study groups.CONCLUSIONS: Compared to healthy lungs, all the grafts showed increased [18F]FDG uptake rate, but there were no differences between patients who developed PGD and patients who did not. Of note, the PGD patients showed a worse inflation status of lungs and a higher inhomogeneity extent.",

author = "Miriam Gotti and Davide Chiumello and Massimo Cressoni and Mariateresa Guanziroli and Matteo Brioni and {Safaee Fakhr}, Bijan and Chiara Chiurazzi and Andrea Colombo and Dario Massari and Ilaria Algieri and Caterina Lonati and Paolo Cadringher and Paolo Taccone and Marta Pizzocri and Jacopo Fumagalli and Lorenzo Rosso and Alessandro Palleschi and Riccardo Benti and Felicia Zito and Franco Valenza and Luciano Gattinoni",

year = "2018",

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doi = "10.23736/S0375-9393.18.12651-4",

language = "English",

volume = "84",

pages = "1169--1177",

journal = "Minerva Anestesiologica",

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TY - JOUR

T1 - Inflammation and primary graft dysfunction after lung transplantation

T2 - CT-PET findings

AU - Gotti, Miriam

AU - Chiumello, Davide

AU - Cressoni, Massimo

AU - Guanziroli, Mariateresa

AU - Brioni, Matteo

AU - Safaee Fakhr, Bijan

AU - Chiurazzi, Chiara

AU - Colombo, Andrea

AU - Massari, Dario

AU - Algieri, Ilaria

AU - Lonati, Caterina

AU - Cadringher, Paolo

AU - Taccone, Paolo

AU - Pizzocri, Marta

AU - Fumagalli, Jacopo

AU - Rosso, Lorenzo

AU - Palleschi, Alessandro

AU - Benti, Riccardo

AU - Zito, Felicia

AU - Valenza, Franco

AU - Gattinoni, Luciano

PY - 2018/10/1

Y1 - 2018/10/1

N2 - BACKGROUND: The leading cause of early mortality after lung transplantation is Primary graft dysfunction (PGD). We assessed the lung inflammation, inflation status and inhomogeneities after lung transplantation. Our purpose was to investigate the possible differences between patients who did or did not develop PGD.METHODS: We designed a prospective observational study enrolling patients who underwent a CT-PET study within 1 week after lung transplantation. Twenty-four patients (10 after double- and 14 after single-lung) were enrolled. Respiratory and hemodynamic data were collected before, during and after lung transplantation. Each patient underwent computed tomography-positron emission tomography (CT-PET) scan early after surgery. Broncho-alveolar lavage (BAL) fluid collection was performed to analyze inflammatory mediators.RESULTS: The grafts showed a [18F]fluoro-2-deoxy-D-glucose ([18F]FDG) uptake rate of 26[18-33]*10-4 mLblood/mLtissue/min (reference values 11[7-15]*10-4). Three double- and six single-lung recipients developed PGD. The grafts of patients who developed PGD had similar [18F]FDG uptake than grafts of patients who did not (28[18-26]*10-4 versus 26[22-31]*10-4, P=0.79). Not-inflated tissue fraction was significantly higher (28[20-38]% versus 14[7-21]%, P=0.01) while well-inflated fraction was significantly lower (29[25-41]% versus 53[39-65]%, P<0.01). Inhomogeneity extent was higher in patients who developed PGD (23[18-26]% versus 14[10-20]%, P=0.01)The lung weight was 650[591-820]g versus 597[480-650]g (P=0.09)). BAL fluid analysis for inflammatory mediators did not detect a difference between the study groups.CONCLUSIONS: Compared to healthy lungs, all the grafts showed increased [18F]FDG uptake rate, but there were no differences between patients who developed PGD and patients who did not. Of note, the PGD patients showed a worse inflation status of lungs and a higher inhomogeneity extent.

AB - BACKGROUND: The leading cause of early mortality after lung transplantation is Primary graft dysfunction (PGD). We assessed the lung inflammation, inflation status and inhomogeneities after lung transplantation. Our purpose was to investigate the possible differences between patients who did or did not develop PGD.METHODS: We designed a prospective observational study enrolling patients who underwent a CT-PET study within 1 week after lung transplantation. Twenty-four patients (10 after double- and 14 after single-lung) were enrolled. Respiratory and hemodynamic data were collected before, during and after lung transplantation. Each patient underwent computed tomography-positron emission tomography (CT-PET) scan early after surgery. Broncho-alveolar lavage (BAL) fluid collection was performed to analyze inflammatory mediators.RESULTS: The grafts showed a [18F]fluoro-2-deoxy-D-glucose ([18F]FDG) uptake rate of 26[18-33]*10-4 mLblood/mLtissue/min (reference values 11[7-15]*10-4). Three double- and six single-lung recipients developed PGD. The grafts of patients who developed PGD had similar [18F]FDG uptake than grafts of patients who did not (28[18-26]*10-4 versus 26[22-31]*10-4, P=0.79). Not-inflated tissue fraction was significantly higher (28[20-38]% versus 14[7-21]%, P=0.01) while well-inflated fraction was significantly lower (29[25-41]% versus 53[39-65]%, P<0.01). Inhomogeneity extent was higher in patients who developed PGD (23[18-26]% versus 14[10-20]%, P=0.01)The lung weight was 650[591-820]g versus 597[480-650]g (P=0.09)). BAL fluid analysis for inflammatory mediators did not detect a difference between the study groups.CONCLUSIONS: Compared to healthy lungs, all the grafts showed increased [18F]FDG uptake rate, but there were no differences between patients who developed PGD and patients who did not. Of note, the PGD patients showed a worse inflation status of lungs and a higher inhomogeneity extent.

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Inflammation and primary graft dysfunction after lung transplantation: CT-PET findings

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