Significance: Chronic lung allograft dysfunction (CLAD) is the leading cause of death in transplant patients who survive past the first year post-transplant. Current diagnosis is based on sustained decline in lung function; there is a need for tools that can identify CLAD onset. Aim: Endoscopic optical coherence tomography (OCT) can visualize structural changes in the small airways, which are of interest in CLAD progression. We aim to identify OCT features in the small airways of lung allografts that correlate with CLAD status. Approach: Imaging was conducted with an endoscopic rotary pullback OCT catheter during routine bronchoscopy procedures (n = 54), collecting volumetric scans of three segmental airways per patient. Six features of interest were identified, and four blinded raters scored the dataset on the presence and intensity of each feature. Results: Airway dilation (AD) was the only feature found to significantly (p < 0.003) correlate with CLAD diagnosis (R = 0.40 to 0.61). AD could also be fairly consistently scored between raters (κinter-rater = 0.48, κintra-rater = 0.64). There is a stronger relationship between AD and the combined obstructive and restrictive (BOS + RAS) phenotypes than the obstructive-only (BOS) phenotype for two raters (R = 0.92 , 0.94). Conclusions: OCT examination of small AD shows potential as a diagnostic indicator for CLAD and CLAD phenotype and merits further exploration.

中文翻译：

---

内窥镜光学相干断层扫描测量的小气道扩张与慢性肺移植功能障碍相关

意义：慢性肺同种异体移植功能障碍 (CLAD) 是移植后存活超过第一年的移植患者死亡的主要原因。目前的诊断是基于肺功能的持续下降；需要能够识别 CLAD 发病的工具。目的：内窥镜光学相干断层扫描 (OCT) 可以可视化小气道的结构变化，这对 CLAD 进展很感兴趣。我们的目标是确定与 CLAD 状态相关的同种异体肺移植小气道中的 OCT 特征。方法：在常规支气管镜检查程序（n = 54）期间使用内窥镜旋转回拉 OCT 导管进行成像，收集每位患者三个节段气道的容积扫描。确定了六个感兴趣的特征，四个不知情的评分者根据每个特征的存在和强度对数据集进行评分。结果：气道扩张 (AD) 是发现与 CLAD 诊断显着 (p < 0.003) 相关的唯一特征 (R = 0.40 至 0.61)。AD 也可以在评分者之间进行相当一致的评分（κinter-rater = 0.48，κintra-rater = 0.64）。AD 与阻塞性和限制性 (BOS + RAS) 组合表型之间的关系比两个评分者的仅阻塞性 (BOS) 表型 (R = 0.92, 0.94) 更强。结论：小 AD 的 OCT 检查显示出作为 CLAD 和 CLAD 表型诊断指标的潜力，值得进一步探索。AD 也可以在评分者之间相当一致地评分（κinter-rater = 0.48，κintra-rater = 0.64）。AD 与阻塞性和限制性 (BOS + RAS) 组合表型之间的关系比两个评分者的仅阻塞性 (BOS) 表型 (R = 0.92, 0.94) 更强。结论：小 AD 的 OCT 检查显示出作为 CLAD 和 CLAD 表型诊断指标的潜力，值得进一步探索。AD 也可以在评分者之间相当一致地评分（κinter-rater = 0.48，κintra-rater = 0.64）。AD 与阻塞性和限制性 (BOS + RAS) 组合表型之间的关系比两个评分者的仅阻塞性 (BOS) 表型 (R = 0.92, 0.94) 更强。结论：小 AD 的 OCT 检查显示出作为 CLAD 和 CLAD 表型诊断指标的潜力，值得进一步探索。