دورية أكاديمية
Airway Oscillometry Detects Spirometric-Silent Episodes of Acute Cellular Rejection.
| العنوان: | Airway Oscillometry Detects Spirometric-Silent Episodes of Acute Cellular Rejection. |
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| المؤلفون: | Cho E; Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada., Wu JKY; Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.; Pulmonary Function Laboratory., Birriel DC; Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.; Toronto Lung Transplant Programme, Multi-Organ Transplant Unit., Matelski J; Biostatistics Research Unit, and., Nadj R; Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada., DeHaas E; Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada., Huang Q; Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada., Yang K; Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada., Xu T; Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada., Cheung AB; Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada., Woo LN; Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada., Day L; Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.; Pulmonary Function Laboratory., Cypel M; Toronto Lung Transplant Programme, Multi-Organ Transplant Unit.; Division of Thoracic Surgery, Department of Surgery, University Health Network, Toronto, Ontario, Canada., Tikkanen J; Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.; Toronto Lung Transplant Programme, Multi-Organ Transplant Unit., Ryan C; Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.; Pulmonary Function Laboratory., Chow CW; Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.; Toronto Lung Transplant Programme, Multi-Organ Transplant Unit. |
| المصدر: | American journal of respiratory and critical care medicine [Am J Respir Crit Care Med] 2020 Jun 15; Vol. 201 (12), pp. 1536-1544. |
| نوع المنشور: | Journal Article; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: American Thoracic Society Country of Publication: United States NLM ID: 9421642 Publication Model: Print Cited Medium: Internet ISSN: 1535-4970 (Electronic) Linking ISSN: 1073449X NLM ISO Abbreviation: Am J Respir Crit Care Med Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2000- : New York, NY : American Thoracic Society Original Publication: New York, NY : American Lung Association, c1994- |
| مواضيع طبية MeSH: | Lung Transplantation*, Airway Resistance/*physiology , Graft Rejection/*diagnosis , Oscillometry/*methods , Respiratory Function Tests/*methods, Acute Disease ; Biopsy ; Bronchoscopy ; Elasticity ; Forced Expiratory Volume ; Glucocorticoids/therapeutic use ; Graft Rejection/drug therapy ; Graft Rejection/pathology ; Graft Rejection/physiopathology ; Humans ; Immunity, Cellular ; Methylprednisolone/therapeutic use ; Spirometry |
| مستخلص: | Rationale: Acute cellular rejection (ACR) is common during the initial 3 months after lung transplant. Patients are monitored with spirometry and routine surveillance transbronchial biopsies. However, many centers monitor patients with spirometry only because of the risks and insensitivity of transbronchial biopsy for detecting ACR. Airway oscillometry is a lung function test that detects peripheral airway inhomogeneity with greater sensitivity than spirometry. Little is known about the role of oscillometry in patient monitoring after a transplant. Objectives: To characterize oscillometry measurements in biopsy-proven clinically significant (grade ≥2 ACR) in the first 3 months after a transplant. Methods: We enrolled 156 of the 209 double lung transplant recipients between December 2017 and March 2019. Weekly outpatient oscillometry and spirometry and surveillance biopsies at Weeks 6 and 12 were conducted at our center. Measurements and Main Results: Of the 138 patients followed for 3 or more months, 15 patients had 16 episodes of grade 2 ACR (AR2) and 44 patients had 64 episodes of grade 0 ACR (AR0) rejection associated with stable and/or improving spirometry. In 15/16 episodes of AR2, spirometry was stable or improving in the weeks leading to transbronchial biopsy. However, oscillometry was markedly abnormal and significantly different from AR0 ( P < 0.05), particularly in integrated area of reactance and the resistance between 5 and 19 Hz, the indices of peripheral airway obstruction. By 2 weeks after biopsy, after treatment for AR2, oscillometry in the AR2 group improved and was similar to the AR0 group. Conclusions: Oscillometry identified physiological changes associated with AR2 that were not discernible by spirometry and is useful for graft monitoring after a lung transplant. |
| التعليقات: | Comment in: Am J Respir Crit Care Med. 2020 Jun 15;201(12):1468-1470. (PMID: 32209030) |
| فهرسة مساهمة: | Keywords: acute rejection; lung transplant; oscillometry |
| المشرفين على المادة: | 0 (Glucocorticoids) X4W7ZR7023 (Methylprednisolone) |
| تواريخ الأحداث: | Date Created: 20200306 Date Completed: 20200831 Latest Revision: 20200831 |
| رمز التحديث: | 20240628 |
| DOI: | 10.1164/rccm.201908-1539OC |
| PMID: | 32135068 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1535-4970 |
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| DOI: | 10.1164/rccm.201908-1539OC |