Ultraschall Med 2020; 41(02): 148-156
DOI: 10.1055/a-0783-2466
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Lung Ultrasound in the Assessment of Pulmonary Complications After Lung Transplantation

Lungenultraschall in der Beurteilung von Komplikationen nach Lungentransplantation
Jesper Rømhild Davidsen
1   Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
2   South Danish Center for Interstitial Lung Diseases (SCILS), Odense University Hospital, Odense, Denmark
3   Clinical Institute, University of Southern Denmark, Denmark
4   Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
,
Hans Henrik Lawaetz Schultz
5   Department of Cardiology, Division of Lung Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
,
Daniel Pilsgaard Henriksen
1   Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
6   Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
,
Martin Iversen
5   Department of Cardiology, Division of Lung Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
,
Anna Kalhauge
7   Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
,
Jørn Carlsen
5   Department of Cardiology, Division of Lung Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
,
Michael Perch
5   Department of Cardiology, Division of Lung Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
,
Ole Graumann
8   Department of Radiology, Odense University Hospital, Odense, Denmark
,
Christian B. Laursen
1   Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
2   South Danish Center for Interstitial Lung Diseases (SCILS), Odense University Hospital, Odense, Denmark
3   Clinical Institute, University of Southern Denmark, Denmark
› Author Affiliations
Further Information

Publication History

22 June 2018

10 October 2018

Publication Date:
09 November 2018 (online)

Abstract

Introduction Lung ultrasound (LUS) has a high diagnostic accuracy for identifying frequent conditions in the post-operative phase after lung transplantation (LTx). This study aimed to investigate the feasibility and clinical ability of LUS to identify pulmonary complications such as pleural effusions and pneumonias in the early postoperative phase after LTx.

Methods A prospective cohort study of lung transplant recipients who consecutively underwent single LTx (SLTx) or double LTx (DLTx) at the National Lung Transplantation Center in Denmark from May 1 to October 31, 2015 was conducted. LUS was performed at four time points corresponding to post-transplant day 3, and weeks 2, 6, and 12 (LUS #1–4) to detect and monitor variation in pathological LUS findings over time. Concurrent with LUS #4, a high-resolution computed tomography examination of the thorax (HRCT) was also performed.

Results 14 patients (1 SLTx/13 DLTx, 7 (50 %) women, mean age: 50.4 years) who had undergone the four prespecified LUS examinations were included. Pleural effusion was the most common condition and most pronounced at post-LTx week 2. Findings consistent with pneumonia increased during week 2 and subsequently decreased. Corresponding to LUS #1, 2, 3, and 4, pleural effusion occurred in 85.7 %, 92.9 %, 85.7 %, and 78.6 %, and pneumonia in 21.4 %, 28.6 %, 14.3 %, and 14.3 %, respectively. HRCT findings at post-LTx week 12 were predominantly presented by unspecific ground glass opacities.

Conclusion In a post-LTx setting, LUS represents a clinical novelty as a feasible diagnostic and monitoring tool to identify pathological pulmonary complications in the early post-operative phase.

Zusammenfassung

Einleitung Lungenultraschall (LUS) hat eine hohe diagnostische Genauigkeit bei der Erkennung häufiger Komplikationen in der postoperativen Phase nach Lungentransplantation (LTx). Ziel dieser Studie war es, die Machbarkeit und die klinische Leistungsfähigkeit von LUS zu untersuchen, was die Erkennung pulmonaler Komplikationen wie Pleuraergüsse und Pneumonien in der frühen postoperativen Phase nach LTx betrifft.

Methoden Eine prospektive Kohortenstudie wurde an Lungentransplantatempfängern durchgeführt, die vom 1. Mai bis zum 31. Oktober 2015 im Nationalen Lungentransplantationszentrum in Dänemark aufeinander folgend einseitige (SLTx) oder beidseitige LTx (DLTx) erhielten. LUS wurde zu 4 verschiedenen Zeitpunkten durchgeführt, entsprechend dem Tag 3 und den Wochen 2, 6 und 12 nach Transplantation (LUS #1–4), um Veränderungen der pathologischen LUS-Befunde im zeitlichen Verlauf zu erkennen und zu überwachen. Parallel zum LUS #4 wurde auch eine hochauflösende Computertomografie des Thorax (HRCT) durchgeführt.

Ergebnisse Es wurden 14 Patienten (1 SLTx/13 DLTx, 7 (50 %) Frauen, Durchschnittsalter: 50,4 Jahre) eingeschlossen, die sich den 4 vorgegebenen LUS-Untersuchungen unterzogen hatten. Die häufigste Komplikation war ein Pleuraerguss, der in der 2. Woche Post-LTx am stärksten ausgeprägt war. Befunde, die für eine Lungenentzündung sprachen, nahmen während der zweiten Woche zu und sanken anschließend ab. Entsprechend den LUS #1–4 trat ein Pleuraerguss in 85,7 % (1), 92,9 % (2), 85,7 % (3) und 78,6 % (4) auf, eine Pneumonie in 21,4 % (1), 28,6 % (2), 14,3 % (3) und 14,3 % (4). HRCT-Befunde in Woche 12 nach LTx zeigten überwiegend unspezifische Milchglas-Trübungen.

Schlussfolgerung In der Post-LTx-Phase ist LUS eine klinische Neuheit als praktikables Diagnose- und Überwachungsverfahren, um pathologische pulmonale Komplikationen in der frühen postoperativen Phase zu erkennen.

 
  • References

  • 1 Weill D, Benden C, Corris PA. et al. A consensus document for the selection of lung transplant candidates: 2014--an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2015; 34: 1-15
  • 2 Burton CM, Milman N, Carlsen J. et al. The Copenhagen National Lung Transplant Group: survival after single lung, double lung, and heart-lung transplantation. J Heart Lung Transplant 2005; 24: 1834-1843
  • 3 Christie JD, Carby M, Bag R. et al. Report of the ISHLT Working Group on Primary Lung Graft Dysfunction part II: definition. A consensus statement of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2005; 24: 1454-1459
  • 4 Ahmad S, Shlobin OA, Nathan SD. Pulmonary complications of lung transplantation. Chest 2011; 139: 402-411
  • 5 Verleden SE, Vandermeulen E, Ruttens D. et al. Neutrophilic reversible allograft dysfunction (NRAD) and restrictive allograft syndrome (RAS). Semin Respir Crit Care Med 2013; 34: 352-360
  • 6 Magnusson J, Westin J, Andersson LM. et al. The impact of viral respiratory tract infections on long-term morbidity and mortality following lung transplantation: a retrospective cohort study using a multiplex PCR panel. Transplantation 2013; 95: 383-388
  • 7 Brown AW, Kaya H, Nathan SD. Lung transplantation in IIP: A review. Respirology 2016; 21: 1173-1184
  • 8 Lichtenstein DA. Lung ultrasound in the critically ill. Ann Intensive Care 2014; 4: 1
  • 9 Laursen CB, Sloth E, Lassen AT. et al. Point-of-care ultrasonography in patients admitted with respiratory symptoms: a single-blind, randomised controlled trial. Lancet Respir Med 2014; 2: 638-646
  • 10 Laursen CB, Sloth E, Lassen AT. et al. Does point-of-care ultrasonography cause discomfort in patients admitted with respiratory symptoms?. Scand J Trauma Resusc Emerg Med 2015; 23: 46
  • 11 Pivetta E, Goffi A, Lupia E. et al. Lung Ultrasound-Implemented Diagnosis of Acute Decompensated Heart Failure in the ED: A SIMEU Multicenter Study. Chest 2015; 148: 202-210
  • 12 Alrajhi K, Woo MY, Vaillancourt C. Test characteristics of ultrasonography for the detection of pneumothorax: a systematic review and meta-analysis. Chest 2012; 141: 703-708
  • 13 Chavez MA, Shams N, Ellington LE. et al. Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis. Respir Res 2014; 15: 50
  • 14 Niemann T, Egelhof T, Bongartz G. Transthoracic sonography for the detection of pulmonary embolism--a meta-analysis. Ultraschall in Med 2009; 30: 150-156
  • 15 Rahman NM, Singanayagam A, Davies HE. et al. Diagnostic accuracy, safety and utilisation of respiratory physician-delivered thoracic ultrasound. Thorax 2010; 65: 449-453
  • 16 Lebovitz DJ, Tabbut M, Latifi SQ. et al. Lung Ultrasound Utility in the Management of the Neurologically Deceased Organ Donor. Prog Transplant 2016; 26: 210-214
  • 17 Davidsen JR, Laursen CB, Bendstrup E. et al. Lung Ultrasound – A Novel Diagnostic Tool To Phenotype Chronic Lung Allograft Dysfunction?. Ultrasound international open 2017; 3: E117-E119
  • 18 Bensted K, McKenzie J, Havryk A. et al. Lung Ultrasound After Transbronchial Biopsy for Pneumothorax Screening in Post-Lung Transplant Patients. Journal of bronchology & interventional pulmonology 2018; 25: 42-47
  • 19 Weber U, Schiefer J, Muhlbacher J. et al. High altitude trekking after lung transplantation: a prospective study using lung ultrasound to detect comets tails for interstitial pulmonary edema in lung transplant recipients and healthy volunteers. Transpl Int 2018; DOI: 10.1111/tri.13307.
  • 20 Belmaati E, Jensen C, Kofoed KF. et al. Primary graft dysfunction; possible evaluation by high resolution computed tomography, and suggestions for a scoring system. Interact Cardiovasc Thorac Surg 2009; 9: 859-867
  • 21 Belmaati EO, Steffensen I, Jensen C. et al. Radiological patterns of primary graft dysfunction after lung transplantation evaluated by 64-multi-slice computed tomography: a descriptive study. Interact Cardiovasc Thorac Surg 2012; 14: 785-791
  • 22 Volpicelli G, Elbarbary M, Blaivas M. et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012; 38: 577-591
  • 23 Lichtenstein DA. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill. Chest 2015; 147: 1659-1670
  • 24 Laursen CB, Davidsen JR, Gleeson FV. Technique and protocols. In: Laursen CB, Rahman NM, Volpicelli G. eds Thoracic Ultrasund [ERS Monograph] Sheffield, European Respiratory Society. 2018: 14-30 [https://doi.org/10.1183/2312508X.10006117
  • 25 Arndt A, Boffa DJ. Pleural space complications associated with lung transplantation. Thorac Surg Clin 2015; 25: 87-95
  • 26 Wahidi MM, Willner DA, Snyder LD. et al. Diagnosis and outcome of early pleural space infection following lung transplantation. Chest 2009; 135: 484-491
  • 27 Dietrich CF, Mathis G, Cui XW. et al. Ultrasound of the pleurae and lungs. Ultrasound Med Biol 2015; 41: 351-365
  • 28 Fishman JA. Infection in solid-organ transplant recipients. N Engl J Med 2007; 357: 2601-2614
  • 29 Parada MT, Alba A, Sepulveda C. Early and late infections in lung transplantation patients. Transplant Proc 2010; 42: 333-335
  • 30 Kocijancic I, Kocijancic K, Cufer T. Imaging of pleural fluid in healthy individuals. Clin Radiol 2004; 59: 826-829