RATIONALE: The chronic rejection of lung allografts is attributable to progressive small airway obstruction. OBJECTIVES: To determine precisely the site and nature of this type of airway obstruction. METHODS: Lungs from patients with rejected lung allografts treated by a second transplant (n = 7) were compared with unused donor (control) lungs (n = 7) using multidetector computed tomography (MDCT) to determine the percentage of visible airways obstructed in each airway generation, micro-computed tomography (microCT) to visualize the site of obstruction, and histology to determine the nature of this obstruction. MEASUREMENTS AND MAIN RESULTS: The number of airways visible with MDCT was not different between rejected and control lungs. However, 10 ± 7% of observed airways greater than 2 mm in diameter, 50 ± 22% of airways between 1 and 2 mm in diameter, and 73 ± 10% of airways less than 1 mm in diameter were obstructed in the rejected lungs. MicroCT confirmed that the mean lumen diameter of obstructed airways was 647 ± 317 μm but showed no difference in either total number and cross-sectional area of the terminal bronchioles or in alveolar dimensions (mean linear intercept) between groups (P > 0.05). In addition, microCT demonstrated that only segments of the airways are obstructed. Histology confirmed a constrictive form of bronchiolitis caused by expansion of microvascular-rich granulation tissue in some locations and collagen-rich scar tissue in others. CONCLUSIONS: Chronic lung allograft rejection is associated with a progressive form of constrictive bronchiolitis that targets conducting airways while sparing larger airways as well as terminal bronchioles and the alveolar surface.
RATIONALE: The chronic rejection of lung allografts is attributable to progressive small airway obstruction. OBJECTIVES: To determine precisely the site and nature of this type of airway obstruction. METHODS: Lungs from patients with rejected lung allografts treated by a second transplant (n = 7) were compared with unused donor (control) lungs (n = 7) using multidetector computed tomography (MDCT) to determine the percentage of visible airways obstructed in each airway generation, micro-computed tomography (microCT) to visualize the site of obstruction, and histology to determine the nature of this obstruction. MEASUREMENTS AND MAIN RESULTS: The number of airways visible with MDCT was not different between rejected and control lungs. However, 10 ± 7% of observed airways greater than 2 mm in diameter, 50 ± 22% of airways between 1 and 2 mm in diameter, and 73 ± 10% of airways less than 1 mm in diameter were obstructed in the rejected lungs. MicroCT confirmed that the mean lumen diameter of obstructed airways was 647 ± 317 μm but showed no difference in either total number and cross-sectional area of the terminal bronchioles or in alveolar dimensions (mean linear intercept) between groups (P > 0.05). In addition, microCT demonstrated that only segments of the airways are obstructed. Histology confirmed a constrictive form of bronchiolitis caused by expansion of microvascular-rich granulation tissue in some locations and collagen-rich scar tissue in others. CONCLUSIONS: Chronic lung allograft rejection is associated with a progressive form of constrictive bronchiolitis that targets conducting airways while sparing larger airways as well as terminal bronchioles and the alveolar surface.
Authors: J Ciaran Hutchinson; Susan C Shelmerdine; Ian C Simcock; Neil J Sebire; Owen J Arthurs Journal: Br J Radiol Date: 2017-05-04 Impact factor: 3.039
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Authors: Stijn E Verleden; Naoya Tanabe; John E McDonough; Dragoş M Vasilescu; Feng Xu; Wim A Wuyts; Davide Piloni; Laurens De Sadeleer; Stijn Willems; Cindy Mai; Jeroen Hostens; Joel D Cooper; Erik K Verbeken; Johny Verschakelen; Craig J Galban; Dirk E Van Raemdonck; Thomas V Colby; Marc Decramer; Geert M Verleden; Naftali Kaminski; Tillie-Louise Hackett; Bart M Vanaudenaerde; James C Hogg Journal: Lancet Respir Med Date: 2020-02-13 Impact factor: 30.700
Authors: S E Verleden; R Vos; E Vandermeulen; D Ruttens; H Bellon; T Heigl; D E Van Raemdonck; G M Verleden; V Lama; B D Ross; C J Galbán; B M Vanaudenaerde Journal: Am J Transplant Date: 2016-07-29 Impact factor: 8.086