Lung Ultrasound in the Assessment of Pulmonary Complications After Lung Transplantation

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.

Key words

chest - lung ultrasound - lung transplantation

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