Figures
- FIGURE 1
Patient flow chart. Thirty-eight patients were included, of which 22 had airway dilatation on CT. Twenty-four and 17 patients were quantitatively analysed for inspiratory CT and paired inspiratory–expiratory CT, respectively. BO: bronchiolitis obliterans; CT: computed tomography; HRCT: high-resolution computed tomography.
- FIGURE 2
Associations between the Reiff score and variables on inspiratory CT. a) CT-TLV/pred TLC and b) LAV−950%. The extent of airway dilatation was expressed by the Reiff score, which assessed the number of lobes involved (with the lingula considered to be a separate lobe) and the degree of dilatation (tubular=1, varicose=2 and cystic=3). The maximum score is 18, and the minimum score is 1 for a patient with airway dilatation. Patients without airway dilatation were scored as 0. CT: computed tomography; pred TLC: predicted total lung capacity; LAV−950%: percentage of low attenuation volume <−950 Hounsfield units.
- FIGURE 3
Longitudinal data of patients with (a–d) and without (e–h) airway dilatation. a) and e) show HRCT of each patient. The airways with a white arrow were measured for lumen. The longitudinal changes in pulmonary function test (unavailable from the middle due to repeating pneumothorax in both patients) and indices on HRCT are presented in (b) and (f). c) and g) show representative lung histology of the patients. The small airways <2 mm in diameter are shown with arrows (white arrow: normal airway, black arrow: narrowing or obstructive airway). [c) elastica Masson stain, g) elastica van Gieson stain]. d) and h) show one of the narrowing and normal airways, respectively, at high magnification of circled airways in (c) and (g) [d) elastica Masson stain, h) elastica van Gieson stain]. BO: bronchiolitis obliterans; FEV1: forced expiratory volume in 1 s; HRCT: high-resolution computed tomography; LAV−950%: percentage of low attenuation volume <−950 Hounsfield units; fSAD: functional small airway disease; RV: residual volume; TLC: total lung capacity.
- FIGURE 4
Pathological measurements related to BO of relatively circular bronchioles. a) The percentage of narrowing or obstructive bronchioles due to BO among the total number of assessed bronchioles per patient and b) thickness of airway wall compartments adjusted by Pbm. c) and d) show the associations between Reiff score and the extent of BO and thickness of subepithelium. The Reiff score assesses the number of lobes involved (with the lingula considered to be a separate lobe) and the degree of dilatation (tubular=1, varicose=2 and cystic=3). The maximum score is 18, and the minimum score is 1 for a patient with airway dilatation. Patients without airway dilatation were scored as 0. The boxes represent the interquartile range with a median (the horizontal line). BO: bronchiolitis obliterans; Pbm: perimeter of the basement membrane. *p<0.05.
Tables
- TABLE 1
Patient characteristics at registration for lung transplantation
Airway dilatation−
n=16Airway dilatation+
n=22p-value Male 9 (56) 9 (41) 0.35 Age, years 33 (14–47) 25 (15–42) 0.43 Height, cm 158 (141–169) 159 (143–164) 0.89 Weight, kg 39.3 (25.7–50.6) 40.0 (28.9–49.6) 0.70 Ex-smokers 1 (6) 3 (14) 0.46 Causes of BO HSCT 14 (88) 20 (91) 0.74 Lung transplantation 2 (13) 2 (9) Bilateral/right/left 0 (0)/1 (6)/1 (6) 2 (9)/0 (0)/0 (0) BO with prominent fibrosis 3 (19) 1 (5) 0.16 Prednisolone use 11 (69) 19 (86) 0.19 Dose, mg·day−1 15 (7.5–15) 8 (4.0–12.5) 0.13 Immunosuppressive agent use 6 (38) 12 (55) 0.30 Inhaled corticosteroid use 10 (63) 12 (55) 0.62 Time from the causes of BO to diagnosis of BO, year 2.3 (0.8–5.2) 1.3 (0.7–2.9) 0.17 Time from the diagnosis of BO to registration, years 1.5 (0.6–4.1) 2.8 (1.1–6.0) 0.15 Age at diagnosis of BO, years 31 (13–44) 21 (12–37) 0.31 Time from registration to lung transplantation#, months 2.4 (0.6–18.8) 1.5 (1.2–17.3) 0.73 Pulmonary function test¶ FVC, % of predicted 48.3 (16.3–68.4) 46.5 (38.9–50.8) 1.00 FEV1, % of predicted 20.1 (16.7–44.0) 22.0 (18.3–23.0) 0.76 FEV1/FVC, % 68.5 (35.0–96.1) 42.7 (34.5–50.1) 0.15 RV, % of predicted 87.0 (54.6–166.2) 176.8 (131.7–236.1) 0.03 RV/TLC, % 46.4 (41.9–50.8) 53.2 (46.9–58.9) 0.12 Pneumonia within the previous year 6 (38) 8 (36) 0.94 Reiff score 0 7 (4–10) – BO: bronchiolitis obliterans; HSCT: hematopoietic stem-cell transplantation; FVC: forced vital capacity; FEV1: forced expiratory volume in 1 s; RV: residual volume; TLC: total lung capacity. All values are expressed as median (interquartile range) except categorical variables, which are expressed as n (%).
#29 patients received living-donor lung transplantation.
¶Available for 21 patients (airway dilatation+ n=12, airway dilatation− n=9).
- TABLE 2
Bacterial culture of the sputum at registration
Airway dilatation−
n=14Airway dilatation+
n=18p-value Streptococcus ssp. 0 (0) 1 (6) 0.37 Staphylococcus ssp. 0 (0) 2 (11) 0.20 Pseudomonas aeruginosa 0 (0) 7 (39) 0.01 Other gram-negative bacilli 2 (14) 3 (17) 0.85 Haemophilus influenzae 1 (7) 0 Klebsiella oxytoca 1 (7) 0 Escherichia coli 0 2 (11) Stenotrophomonas maltophilia 0 1 (6) Normal flora only 12 (86) 8 (44) 0.02 No growth 0 (0) 1 (6) 0.37 All values are expressed as n (%).
- TABLE 3
Quantitative analysis for inspiratory CT (A) and paired inspiratory and expiratory CT (B) among patients with and without airway dilatation
A Airway dilatation−
n=10Airway dilatation+
n=14p-value CT-TLV/pred TLC, % 42.0 (21.3–58.9) 69.7 (56.7–97.0) 0.009 LAV−950%, % 15.3 (5.7–25.1) 29.3 (15.1–41.7) 0.050 B Airway dilatation−
n=7Airway dilatation+
n=10p-value LAV−856%, % 46.3 (0.6–57.2) 66.5 (54.1–72.6) 0.036 fSAD, % 10.0 (0.2–33.9) 34.7 (28.3–36.4) 0.057 CT-TLV: total lung capacity calculated on inspiratory CT; pred TLC: predicted total lung capacity; LAV−950%: low attenuation volume <−950 Hounsfield units (HU) at end inspiration; LAV−856%: low attenuation volume <−856 HU at end expiration; fSAD: functional small airway disease. All values are expressed as median (interquartile range).
