Short summary

Lung ultrasound (LUS) has not previously been investigated in the perspective of diagnosing acute complications in the recovery after lung transplantation. The purpose of this study was to explore whether LUS is applicable in a clinical setting to identify acute complications in newly lung transplanted patients.

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Rationale

Lung ultrasound (LUS) has during the past 20 years undergone an enormous development and is now used in a number of specialties such as respiratory medicine, emergency medicine, anesthesiology and traumatology due to a high sensitivity to diagnose pleura pulmonary conditions involving diffuse interstitial edema, pulmonary edema, hemo- and pneumothorax, ARDS, pleural effusion, interstitial inflammation and fibrosis. Moreover, in a number of studies LUS has been used to monitor treatment response in various lung diseases including pneumonia, pulmonary edema, and pneumothorax.

LUS has not previously been investigated in the perspective of diagnosing acute complications in the postoperative recovery phase after lung transplantation (LTx). The risk of acute lung allograft dysfunction (ALAD) such as primary graft dysfunction or due to e.g. hemorrhage, pulmonary embolism, infection, antibody mediated rejection and acute rejection is highest the first 2 years, and especially during the first three months after LTx. Many of these conditions are expected to be diagnosed on basis of LUS, but so far no studies have examined this approach.

This pilot project is expected to result in an increased knowledge of the applicability of LUS in the postoperative recovery phase after LTx with primarily identification of pathognomonic findings or patterns of ALAD during the first three months after LTx. Such knowledge may add to a more rapidly assessment of requirements for treatment of acute rejection or conditions leading hereto, and consequently be expected to contribute to an improved postoperative prognosis in addition to enhanced quality of life. 

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Description of the cohort

During 1 May and 31 October 2015 all patients who had underwent single (SLTx) or double LTx (DLTx) at Rigshospitalet (Copenhagen University Hospital), Heart Centre, Divison of Lung Transplantaion, were included. All participants gave written informed consent.

Data and biological material

The inclusion and data collection phase is terminated with the last LUS performed 18 January 2016. Fourteen lung transplanted patients were included (13 DLTx, 1 SLTx) and all had LUS performed according to day 3, 14, 42 and 84 after LTx and a high resolution computed tomography (HRCT) scan on day 84 after LTx.

1. The tendency of the LUS findings throughout the individual 84 days post-LTx period corresponding to the four LUS performances will be analysed and evaluated in order to identify potential and typical LUS findings/patterns.
2. LUS and HRCT (used as golden standard) findings will be compared to assess LUS as a diagnostic and monitoring tool for ALAD findings/patterns corresponding to day 84 after LTx. The LUS findings will be reviewed in consensus between two experienced pulmonologists in LUS. HRCT findings will be reviewed in consensus between one pulmonologists and one radiologist, both experienced in assessing LTx related HRCTs. The consensus findings from the LUS-group will be blinded to the HRCT-group and vice versa. 

Collaborating researchers and departments

Division of Lung Transplantation, Heart Centre, Copenhagen University Hospital, Rigshospitalet

• PhD-Fellow Hans Henrik Schultz, MD
• Associate Professor Martin Iversen, MD, DMSci
• Michael Perch, MD
• Associate Professor Jørn Carlsen, MD, DMSci

Department of Radiology, Copenhagen University Hospital, Rigshospitalet

• Anna Kalhauge, MD

Research Unit of Respiratory Medicine, Department of Respiratory Medicine, Odense University Hospital

• Clinical Associate Professor Christian Borbjerg Laursen, MD, PhD
• Daniel Pilsgaard Henriksen, MD, PhD

Publications associated with the project

Lung Ultrasound in the Assessment of Pulmonary Complications After Lung Transplantation. /Davidsen JR, Schultz HHL, Henriksen DP, Iversen M, Kalhauge A, Carlsen J, Perch M, Graumann O, Laursen CB / DOI: 10.1055/a-0783-2466