BACKGROUND Restrictive allograft syndrome (RAS) after lung transplantation (LTx) is associated with the poorer graft survival in patients with chronic lung allograft dysfunction (CLAD). Nevertheless, its diagnostic criteria have not been clearly defined after single-LTx (SLTx). Hence, we studied an SLTx cohort with CLAD to investigate the utility of both computed tomography (CT)-score/volume measures and functional spirometric criteria for the early identification of RAS in this population. METHODS We included 51 patients with SLTx (17 RAS, 17 bronchiolitis obliterans syndrome [BOS], and 17 stable condition). The criteria for RAS diagnosis in SLTx included forced vital capacity (FVC) <80% baseline (BL) or forced expiratory volume in 1 second (FEV1) <80% BL with an FEV1/FVC ratiounchanged or >0.7 and persistent CT-scan-lung opacities. We defined 4 time points (T): T-baseline, T-onset (first CT-scan-opacities), T-follow-up, and T-last. RESULTS In patients with RAS, the spirometric criteria for RAS at T-onset were reached in only 47% (FVC decline <80% BL [(29%] or FEV1 <80% BL/ratiounchanged or >0.7 [41%]), whereas at the same T-onset date, the graft CT-score increased to 5 (4-6) vs 1 (0-2) at baseline (p < 0.001) (CT - score ≥2 at T-onset in 100% and ΔCT - score ≥2 in 74% of patients with RAS), and the median CT-scan graft volume decreased to 1,722 ml (vs 1,796 ml at T-baseline, p = 0.003) (decreased CT-graft - volume <90% BL in 50% of patients). In contrast, in patients with BOS, CT-score/volume were unchanged at T-onset vs T-baseline (p = 0.8, p = 0.68, respectively). CONCLUSION Our results suggest that the use of a simple CT-score and to a lesser extent, CT-volume measures, might allow for the early identification and/or prediction of RAS in SLTx rather than functional criteria.

中文翻译：

---

使用CT-SCAN评分和体积测量来早期识别单肺移植受者的限制性同种异体移植综合征。

背景技术肺移植（LTx）后的限制性同种异体移植综合征（RAS）与慢性肺同种异体移植功能障碍（CLAD）患者的较差的移植物存活率相关。但是，单次LTx（SLTx）后其诊断标准尚未明确定义。因此，我们与CLAD研究了SLTx队列，以研究计算机断层扫描（CT）得分/体积测量和功能肺活量测定标准在该人群中早期识别RAS的实用性。方法我们纳入了51例SLTx患者（17 RAS，17闭塞性细支气管炎综合征[BOS]和17病情稳定）。SLTx中RAS诊断的标准包括强制肺活量（FVC）<基线的80％（BL）或1秒内强制呼气量（FEV1）<80％BL，FEV1 / FVC比率不变或> 0.7，并且持续进行CT扫描肺部混浊。我们定义了4个时间点（T）：T基线，T发作（第一次CT扫描不透明度），T追踪和T持续。结果在RAS患者中，T发作时RAS的肺活量测定标准仅达到47％（FVC下降<80％BL [（29％]或FEV1 <80％BL /比率不变或> 0.7 [41％]），而在相同的T发作日期，移植物的CT评分从基线时的5（4-6）相对于1（0-2）升高（p <0.001）（CT-T发作≥2的比例分别为100％和ΔCT-74％的RAS患者得分≥2），并且CT扫描移植物的中位数减少至1,722 ml（T基线为1,796 ml，p = 0.003）（CT移植物减少-体积<90％BL在50％的患者中），与此相反，在BOS患者中，T发作vs T基线的CT得分/容量不变（分别为p = 0.8，p = 0.68）。简单的CT评分（程度较小），