%0 Journal Article %A Mariko Kogo %A Hisako Matsumoto %A Naoya Tanabe %A Toyofumi F. Chen-Yoshikawa %A Naoki Nakajima %A Akihiko Yoshizawa %A Tsuyoshi Oguma %A Susumu Sato %A Natsuko Nomura %A Chie Morimoto %A Hironobu Sunadome %A Shimpei Gotoh %A Akihiro Ohsumi %A Hiroshi Date %A Toyohiro Hirai %T The importance of central airway dilatation in patients with bronchiolitis obliterans %D 2021 %R 10.1183/23120541.00123-2021 %J ERJ Open Research %P 00123-2021 %X Background Bronchiolitis obliterans (BO) is a clinical syndrome characterised by progressive small airway obstruction, causing significant morbidity and mortality. Central airway dilatation is one of its radiological characteristics, but little is known about the clinical and pathological associations between airway dilatation and BO.Methods This retrospective study consecutively included patients who underwent lung transplantation due to BO at Kyoto University Hospital from 2009 to 2019. Demographic and histopathological findings of the resected lungs were compared between patients with and without airway dilatation measured by chest computed tomography (CT) at registration for lung transplantation.Results Of a total of 38 included patients (median age, 30 years), 34 (89%) had a history of hematopoietic stem-cell transplantation, and 22 (58%) had airway dilatation based on CT. Patients with airway dilatation had a higher frequency of Pseudomonas aeruginosa isolation with greater residual volume than those without airway dilatation. Quantitative CT analysis revealed an increase in lung volume to predictive total lung capacity and a percentage of low attenuation volume <−950 HU at inspiration in association with the extent of airway dilatation. Airway dilatation on CT was associated with an increased number of bronchioles with concentric narrowing of the lumen and thickening of the subepithelium of the walls on histology.Conclusions In patients with BO, airway dilatation may reflect increased residual volume or air-trapping and pathological extent of obstructive bronchioles, accompanied by a risk of Pseudomonas aeruginosa isolation. More attention should be paid to the development of airway dilatation in the management of BO.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Dr. Kogo has nothing to disclose.Conflict of interest: Dr. Matsumoto has nothing to disclose.Conflict of interest: Dr. Tanabe reports grants from FUJIFILM, during the conduct of the study; personal fees from AstraZeneka, personal fees from Nippon Boehringer Ingelheim, personal fees from GlaxoSmithKline, outside the submitted work.Conflict of interest: Dr. Chen-Yoshikawa has nothing to disclose.Conflict of interest: Dr. Nakajima has nothing to disclose.Conflict of interest: Dr. Yoshizawa has nothing to disclose.Conflict of interest: T. Oguma reports research grants from FUJIFILM Corporation, and lecture fees from AstraZeneca, KYORIN Pharmaceutical, GlaxoSmithKline and Novartis, outside the submitted work.Conflict of interest: Dr. Sato reports grants from Nippon Boehringer Ingelheim, outside the submitted work; .Conflict of interest: Dr. Nomura has nothing to disclose.Conflict of interest: Dr. Morimoto has nothing to disclose.Conflict of interest: Dr. Sunadome has nothing to disclose.Conflict of interest: S. Gotoh reports grants from Kyorin Pharmaceutical Co. Ltd, Fujifilm Wako Pure Chemical Corp. and the Japan Agency for Medical Research and Development, and is a founder of and shareholder in HiLung. Inc., outside the submitted work.Conflict of interest: Dr. Ohsumi has nothing to disclose.Conflict of interest: Dr. Date has nothing to disclose.Conflict of interest: Dr. Hirai has nothing to disclose. %U https://openres.ersjournals.com/content/erjor/early/2021/06/03/23120541.00123-2021.full.pdf