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Lung clearance index in detection of post-transplant bronchiolitis obliterans syndrome

Madeleine Driskel, Alex Horsley, Laurice Fretwell, Nigel Clayton, Mohamed Al-Aloul
ERJ Open Research 2019 5: 00164-2019; DOI: 10.1183/23120541.00164-2019
Madeleine Driskel
1Lung Function Laboratory, Manchester University NHS Foundation Trust, Manchester, UK
2Cardiothoracic Transplant Unit, Manchester University NHS Foundation Trust, Manchester, UK
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  • ORCID record for Madeleine Driskel
Alex Horsley
3Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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  • For correspondence: alexander.horsley@manchester.ac.uk
Laurice Fretwell
4School of Human Sciences, University of Derby, Derby, UK
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Nigel Clayton
1Lung Function Laboratory, Manchester University NHS Foundation Trust, Manchester, UK
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Mohamed Al-Aloul
2Cardiothoracic Transplant Unit, Manchester University NHS Foundation Trust, Manchester, UK
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  • FIGURE 1
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    FIGURE 1

    Forced expiratory volume in the first second (FEV1) and forced expiratory flow at 25–75% of forced vital capacity (FEF25–75%) values as % best from baseline, against lung clearance index (LCI).

  • FIGURE 2
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    FIGURE 2

    Lung clearance index (LCI) against International Society for Heart and Lung Transplantation (ISHLT) bronchiolitis obliterans syndrome (BOS) grade. Bars represent group mean and standard deviation. p-values represent unpaired t-tests. Median LCI for BOS-2–3 was statistically higher than in all other groups (p<0.001, Mann–Whitney test).

  • FIGURE 3
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    FIGURE 3

    Lung clearance index (LCI) in patients with bronchiolitis obliterans syndrome (BOS) on high-resolution computed tomography (HRCT), no BOS on HRCT and those with no HRCT performed. Bars represent group mean and standard deviation. #: Mann–Whitney test; ¶: t-test.

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    FIGURE 4

    a) Ventilation heterogeneity of the conductive lung zone (Scond) and b) ventilation heterogeneity of the acinar lung zone (Sacin) against International Society for Heart and Lung Transplantation (ISHLT) bronchiolitis obliterans syndrome (BOS) grade. Bars represent group mean and standard deviation. For details of the statistical differences between groups, see table 1.

Tables

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  • TABLE 1

    Summary of demographics and results across International Society for Heart and Lung Transplantation bronchiolitis obliterans syndrome (BOS) grades

    OverallNo BOSBOS-0pBOS-1BOS-2–3p-value
    Subjects511516119
    Age years51.5±13.747.4±16.852.6±10.952.2±13.955.6±12.50.690§
    Time since transplant years4.0 (0.9–5.9)1.0 (0.6–8.8)4.1 (2.4–4.8)3.6 (0.9–6.3)5.0 (3.9–6.1)0.735ƒ
    FEV1 % predicted87 (68–95)95 (94–97)*,#,¶90±4.7*,#,¶74±5.6*,¶,+56±8.2*,#,+<0.0001ƒ
    LCI8.8 (7.4–9.9)7.6±0.84*,#,¶8.3±1.0*,#,¶9.3±1.0*,¶,+12.5 (10.8–14.1)*,#,+<0.0001ƒ
    Scond0.04 (0.02–0.07)0.02±0.017*,#,¶0.04±0.03*,¶0.06±0.04+0.09±0.04+<0.0001§
    Sacin0.24±0.130.19±0.08¶0.19±0.11¶0.23±0.06¶0.40±0.12*,#,+<0.0001§

    Data are presented as mean±sd or median (interquartile range), unless otherwise stated. For post hoc comparisons, unpaired t-tests were used where both cohorts were normally distributed (data expressed as mean±sd) or Mann–Whitney test for all others. FEV1: forced expiratory volume in the first second; LCI: lung clearance index; Scond: ventilation heterogeneity of the conductive lung zone; Sacin: ventilation heterogeneity of the acinar lung zone. *: p<0.05 versus BOS-0p, post hoc pairwise comparison; #: p<0.05 versus BOS-1, post hoc pairwise comparison; ¶: p<0.05 versus BOS-2–3, post hoc pairwise comparison; +: p<0.05 versus no BOS, post hoc pairwise comparison; §: ANOVA; ƒ: Kruskal–Wallis test.

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      Supplementary material 00164-2019.SUPPLEMENT

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    Lung clearance index in detection of post-transplant bronchiolitis obliterans syndrome
    Madeleine Driskel, Alex Horsley, Laurice Fretwell, Nigel Clayton, Mohamed Al-Aloul
    ERJ Open Research Oct 2019, 5 (4) 00164-2019; DOI: 10.1183/23120541.00164-2019

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    Lung clearance index in detection of post-transplant bronchiolitis obliterans syndrome
    Madeleine Driskel, Alex Horsley, Laurice Fretwell, Nigel Clayton, Mohamed Al-Aloul
    ERJ Open Research Oct 2019, 5 (4) 00164-2019; DOI: 10.1183/23120541.00164-2019
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