Radiological distribution patterns in restrictive chronic lung allograft dysfunction: Impact on survival across all phenotypes
Background: Restrictive chronic lung allograft dysfunction (CLAD) demonstrates poor outcomes after lung transplantation. However, the impact of radiological patterns on survival within a restrictive CLAD under the new International Society for Heart and Lung Transplantation (ISHLT) criteria remains...
Saved in:
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-05-01
|
| Series: | JHLT Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950133425000278 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850040416782516224 |
|---|---|
| author | Taiki Fukuda, MD, PhD Yusei Nakamura, MD Shu-Chi Tseng, MD Yuki Ko, MD, PhD Staci M. Gagne, MD Takeshi Johkoh, MD, PhD Yi Li, PhD David C. Christiani, MD, MPH, MS Hiroya Ojiri, MD, PhD Lynette Sholl, MD Mizuki Nishino, MD, MPH Hiroto Hatabu, MD, PhD |
| author_facet | Taiki Fukuda, MD, PhD Yusei Nakamura, MD Shu-Chi Tseng, MD Yuki Ko, MD, PhD Staci M. Gagne, MD Takeshi Johkoh, MD, PhD Yi Li, PhD David C. Christiani, MD, MPH, MS Hiroya Ojiri, MD, PhD Lynette Sholl, MD Mizuki Nishino, MD, MPH Hiroto Hatabu, MD, PhD |
| author_sort | Taiki Fukuda, MD, PhD |
| collection | DOAJ |
| description | Background: Restrictive chronic lung allograft dysfunction (CLAD) demonstrates poor outcomes after lung transplantation. However, the impact of radiological patterns on survival within a restrictive CLAD under the new International Society for Heart and Lung Transplantation (ISHLT) criteria remains unclear. Methods: We analyzed retrospectively 241 bilateral lung transplant recipients between 2005 and 2021. CLAD was diagnosed and classified per the 2019 ISHLT criteria. Restrictive phenotype included restrictive allograft syndrome (RAS) and mixed phenotype. In these cases, RAS-like opacities (RLOs) were evaluated both qualitatively and semiquantitatively on computed tomography at CLAD diagnosis. RLOs were classified into upper-predominant and diffuse/lower-predominant distribution groups. Overall survival after CLAD diagnosis was assessed using Kaplan-Meier method with log-rank test and Cox proportional hazards models. Results: Eighty-three patients were diagnosed with CLAD after transplantation. Twenty-one (25.3%) had restrictive phenotype, which showed shorter survival compared to bronchiolitis obliterans syndrome (median survival: 19.8 vs 68.1 months; hazard ratio [HR], 4.53; 95% confidence interval [CI], 1.96-10.49; p < 0.001). Within the restrictive phenotype, the upper-predominant group demonstrated longer survival than the diffuse/lower-predominant group (median survival: 61.1 vs 15.5 months; p = 0.008). The diffuse/lower-predominant group had shorter survival compared to any other CLAD phenotype (HR, 8.45; 95% CI, 3.40-21.04; p < 0.001). The extent of RLOs within each distribution pattern was not significantly associated with survival. Conclusions: In restrictive phenotype CLAD, RLO distribution patterns determined survival outcomes, with diffuse/lower-predominant showing the poorest prognosis, while the extent of RLOs within each pattern did not correlate with prognosis. |
| format | Article |
| id | doaj-art-64af6e68e61644ef8916517c3d28fd56 |
| institution | DOAJ |
| issn | 2950-1334 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JHLT Open |
| spelling | doaj-art-64af6e68e61644ef8916517c3d28fd562025-08-20T02:56:06ZengElsevierJHLT Open2950-13342025-05-01810023210.1016/j.jhlto.2025.100232Radiological distribution patterns in restrictive chronic lung allograft dysfunction: Impact on survival across all phenotypesTaiki Fukuda, MD, PhD0Yusei Nakamura, MD1Shu-Chi Tseng, MD2Yuki Ko, MD, PhD3Staci M. Gagne, MD4Takeshi Johkoh, MD, PhD5Yi Li, PhD6David C. Christiani, MD, MPH, MS7Hiroya Ojiri, MD, PhD8Lynette Sholl, MD9Mizuki Nishino, MD, MPH10Hiroto Hatabu, MD, PhD11Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts; Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan; Corresponding author: Taiki Fukuda, MD, PhD, Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115.Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts; Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JapanDepartment of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, TaiwanCenter for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MassachusettsCenter for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts; Department of Imaging, Dana-Farber Cancer Institute, Boston, MassachusettsDepartment of Radiology, Kansai Rosai Hospital, Hyogo, JapanDepartment of Biostatistics, University of Michigan, Ann Arbor, MichiganDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MassachusettsDepartment of Radiology, The Jikei University School of Medicine, Tokyo, JapanDepartment of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MassachusettsCenter for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts; Department of Imaging, Dana-Farber Cancer Institute, Boston, MassachusettsCenter for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MassachusettsBackground: Restrictive chronic lung allograft dysfunction (CLAD) demonstrates poor outcomes after lung transplantation. However, the impact of radiological patterns on survival within a restrictive CLAD under the new International Society for Heart and Lung Transplantation (ISHLT) criteria remains unclear. Methods: We analyzed retrospectively 241 bilateral lung transplant recipients between 2005 and 2021. CLAD was diagnosed and classified per the 2019 ISHLT criteria. Restrictive phenotype included restrictive allograft syndrome (RAS) and mixed phenotype. In these cases, RAS-like opacities (RLOs) were evaluated both qualitatively and semiquantitatively on computed tomography at CLAD diagnosis. RLOs were classified into upper-predominant and diffuse/lower-predominant distribution groups. Overall survival after CLAD diagnosis was assessed using Kaplan-Meier method with log-rank test and Cox proportional hazards models. Results: Eighty-three patients were diagnosed with CLAD after transplantation. Twenty-one (25.3%) had restrictive phenotype, which showed shorter survival compared to bronchiolitis obliterans syndrome (median survival: 19.8 vs 68.1 months; hazard ratio [HR], 4.53; 95% confidence interval [CI], 1.96-10.49; p < 0.001). Within the restrictive phenotype, the upper-predominant group demonstrated longer survival than the diffuse/lower-predominant group (median survival: 61.1 vs 15.5 months; p = 0.008). The diffuse/lower-predominant group had shorter survival compared to any other CLAD phenotype (HR, 8.45; 95% CI, 3.40-21.04; p < 0.001). The extent of RLOs within each distribution pattern was not significantly associated with survival. Conclusions: In restrictive phenotype CLAD, RLO distribution patterns determined survival outcomes, with diffuse/lower-predominant showing the poorest prognosis, while the extent of RLOs within each pattern did not correlate with prognosis.http://www.sciencedirect.com/science/article/pii/S2950133425000278lung transplantchronic lung allograft dysfunctionrestrictive allograft syndromeprognosiscomputed tomography |
| spellingShingle | Taiki Fukuda, MD, PhD Yusei Nakamura, MD Shu-Chi Tseng, MD Yuki Ko, MD, PhD Staci M. Gagne, MD Takeshi Johkoh, MD, PhD Yi Li, PhD David C. Christiani, MD, MPH, MS Hiroya Ojiri, MD, PhD Lynette Sholl, MD Mizuki Nishino, MD, MPH Hiroto Hatabu, MD, PhD Radiological distribution patterns in restrictive chronic lung allograft dysfunction: Impact on survival across all phenotypes JHLT Open lung transplant chronic lung allograft dysfunction restrictive allograft syndrome prognosis computed tomography |
| title | Radiological distribution patterns in restrictive chronic lung allograft dysfunction: Impact on survival across all phenotypes |
| title_full | Radiological distribution patterns in restrictive chronic lung allograft dysfunction: Impact on survival across all phenotypes |
| title_fullStr | Radiological distribution patterns in restrictive chronic lung allograft dysfunction: Impact on survival across all phenotypes |
| title_full_unstemmed | Radiological distribution patterns in restrictive chronic lung allograft dysfunction: Impact on survival across all phenotypes |
| title_short | Radiological distribution patterns in restrictive chronic lung allograft dysfunction: Impact on survival across all phenotypes |
| title_sort | radiological distribution patterns in restrictive chronic lung allograft dysfunction impact on survival across all phenotypes |
| topic | lung transplant chronic lung allograft dysfunction restrictive allograft syndrome prognosis computed tomography |
| url | http://www.sciencedirect.com/science/article/pii/S2950133425000278 |
| work_keys_str_mv | AT taikifukudamdphd radiologicaldistributionpatternsinrestrictivechroniclungallograftdysfunctionimpactonsurvivalacrossallphenotypes AT yuseinakamuramd radiologicaldistributionpatternsinrestrictivechroniclungallograftdysfunctionimpactonsurvivalacrossallphenotypes AT shuchitsengmd radiologicaldistributionpatternsinrestrictivechroniclungallograftdysfunctionimpactonsurvivalacrossallphenotypes AT yukikomdphd radiologicaldistributionpatternsinrestrictivechroniclungallograftdysfunctionimpactonsurvivalacrossallphenotypes AT stacimgagnemd radiologicaldistributionpatternsinrestrictivechroniclungallograftdysfunctionimpactonsurvivalacrossallphenotypes AT takeshijohkohmdphd radiologicaldistributionpatternsinrestrictivechroniclungallograftdysfunctionimpactonsurvivalacrossallphenotypes AT yiliphd radiologicaldistributionpatternsinrestrictivechroniclungallograftdysfunctionimpactonsurvivalacrossallphenotypes AT davidcchristianimdmphms radiologicaldistributionpatternsinrestrictivechroniclungallograftdysfunctionimpactonsurvivalacrossallphenotypes AT hiroyaojirimdphd radiologicaldistributionpatternsinrestrictivechroniclungallograftdysfunctionimpactonsurvivalacrossallphenotypes AT lynetteshollmd radiologicaldistributionpatternsinrestrictivechroniclungallograftdysfunctionimpactonsurvivalacrossallphenotypes AT mizukinishinomdmph radiologicaldistributionpatternsinrestrictivechroniclungallograftdysfunctionimpactonsurvivalacrossallphenotypes AT hirotohatabumdphd radiologicaldistributionpatternsinrestrictivechroniclungallograftdysfunctionimpactonsurvivalacrossallphenotypes |