Yun-Hyeon Kim MD, PRESENTER: Nothing to Disclose

Abstract: HTML Purpose: Usual interstitial pneumonia (UIP) usually pursues a progressive course with high mortality. Although no drug regimen has proven effective, some reports suggest a positive response to cyclosporine. We evaluated UIP patients treated with single lung transplantation (SLT) to determine whether potent immunosuppressive regimens prevent progression of fibrosis. Serial CT scans were used a surrogate measure of response, as clinical data after SLT reflects function of both the allograft and native fibrotic lung. Methods and Materials: Retrospective review of transplant databases at six institutions identified 34 SLT recipients with pathologically-proved UIP and pre- and post-transplant chest CT scans who survived at least 30 days post SLT. There were 30 men and four women, age 30-68 years (mean 54). Mean time from pre-transplant CT to surgery was 426 days; mean time from surgery to first post-transplant CT was 520 days. Seventeen patients had two or more post-transplant CTs. Immunosuppressive regimens varied; cyclosporine was included in all but five patients. Two thoracic radiologists independently reviewed pre- and post-transplant CT scans in random order. Individual lobes were scored for fibrosis (FIB): 0 = no fibrosis; 1 = septal thickening without honeycombing; 2 = septal thickening with honeycombing involving up to 25% of the lobe; 3 = 26-50%; 4 = 51-75%; and 5 = 76-100% involvement. Ground glass attenuation (GGA) and overall extent (EXT) of disease were scored: 0 = no disease; 1 = 1-5% of the lobe; 2 = 6-25%; 3 = 26-50%; 4 = 51-75%; 5 = 76-100%. Whole lung FIB, GGA, and EXT scores were calculated for each native lung by averaging lobar scores. Differences between mean whole lung scores on serial CTs were compared using the Wilcoxon signed rank test. Results: Mean whole lung scores for GGA, FIB and EXT in the native lungs on pre-transplant CT were 2.69, 2.15, and 3.85, respectively. The mean whole lung GGA score decreased on the first post transplant CT, but not significantly (p > 0.05). The mean whole lung FIB and EXT scores significantly increased, by 0.76 (p = 0.0001) and 0.44 (p = 0.006), respectively. When comparing pre-and last post-transplant CT in 17 patients with multiple post-transplant CT scans, the mean whole lung FIB (mean 0.91, p=0.0001) and EXT (mean 0.53, p=0.0008) scores further increased. Conclusion: Potent immunosuppressive regimens used after lung transplantation did not prevent progression of fibrosis in the native lungs of SLT recipients.       Questions about this event email: mcada003@mc.duke.edu

Kim MD, Y, Progression of Usual Interstitial Pneumonia in Native Lungs after Single Lung Transplantation.  Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL. http://archive.rsna.org/2003/3106660.html