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ORIGINAL ARTICLE   Free accessfree

Minerva Anestesiologica 2018 October;84(10):1169-77

DOI: 10.23736/S0375-9393.18.12651-4


language: English

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

Miriam GOTTI 1, 2, Davide CHIUMELLO 1, 3, 4, Massimo CRESSONI 3, Mariateresa GUANZIROLI 2, Matteo BRIONI 2, Bijan SAFAEE FAKHR 2, Chiara CHIURAZZI 2, 5, Andrea COLOMBO 2, Dario MASSARI 2, Ilaria ALGIERI 2, 6, Caterina LONATI 4, 7, Paolo CADRINGHER 4, Paolo TACCONE 4, Marta PIZZOCRI 2, Jacopo FUMAGALLI 2, Lorenzo ROSSO 8, Alessandro PALLESCHI 8, Riccardo BENTI 9, Felicia ZITO 9, Franco VALENZA 2, 10, Luciano GATTINONI 11

1 Emergency Department, ASST Santi Paolo e Carlo, Milan, Italy; 2 Department of Physical-Surgical Pathophysiology and Transplantation, University of Milan, Milan, Italy; 3 Department of Health Sciences, University of Milan, Milan, Italy; 4 Department of Anesthesia-Resuscitation and Emergency Medicine, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy; 5 Humanitas Clinical and Research Center, Rozzano, Milan, Italy; 6 Humanitas San Pio X, Milan, Italy; 7 Preclinical and Surgical Research Service, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy; 8 Department of Multispecialistic Units and Transplants, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy; 9 Department of Services, Unit of Nuclear Medicine, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy; 10 Department of Anesthesia and Intensive Care Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; 11 Department of Anesthesiology, University of Gottingen, Gottingen, Germany

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.

KEY WORDS: Lung transplantation - Primary graft dysfunction - Positron emission tomography computed tomography - Respiratory insufficiency - Ventilator-induced lung injury

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