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dc.contributor.authorDriskel, Madeleine
dc.contributor.authorHorsley, Alex
dc.contributor.authorFretwell, Laurice
dc.contributor.authorClayton, Nigel
dc.contributor.authorAl-Aloul, Mohamed
dc.date.accessioned2019-10-25T11:04:13Z
dc.date.available2019-10-25T11:04:13Z
dc.date.issued2019-10-15
dc.identifier.citationDriskel, M., Horsley, A., Fretwell, L., Clayton, N. and Al-Aloul, M., (2019). 'Lung clearance index in detection of post-transplant bronchiolitis obliterans syndrome'. ERJ Open Research, 5(4), pp, 1-8. DOI: 10.1183/23120541.00164-2019en_US
dc.identifier.doi10.1183/23120541.00164-2019
dc.identifier.urihttp://hdl.handle.net/10545/624253
dc.description.abstractLong-term outcomes after lung transplantation are often limited by the development of obliterative bronchiolitis (OB), which is clinically defined using spirometry as bronchiolitis obliterans syndrome (BOS). Lung clearance index (LCI), derived from multiple breath washout (MBW) testing, is a global measure of ventilation heterogeneity that has previously been shown to be a more sensitive measure of obstructive small airway diseases than spirometry. We aimed to assess the feasibility of LCI in adult lung transplant patients and to compare LCI to BOS grade. 51 stable adult double-lung transplant recipients performed sulfur hexafluoride MBW in triplicate on a single occasion, using a closed-circuit Innocor device. BOS grades were derived from serial spirometry according to International Society for Heart and Lung Transplantation criteria and, where available, high-resolution computed tomography (HRCT) evidence of OB was recorded. LCI was successfully performed in 98% of patients. The within-visit coefficient of variation for repeat LCI measurements was 3.1%. Mean LCI increased significantly with BOS grades: no BOS (n=15), LCI 7.6; BOS-0p (n=16), LCI 8.3; BOS-1 (n=11), LCI 9.3; BOS-2–3 (n=9), LCI 13.2 (p<0.001). 27 patients had HRCT within 12 months. LCI in those with HRCT evidence of OB was higher than those without OB (11.1 versus 8.2, p=0.006). 47% patients displayed abnormal LCI (>7) despite a normal forced expiratory volume in 1 s (FEV1) (>80% of baseline). LCI measurement in lung transplant recipients is feasible and reproducible. LCI increased with increasing BOS grade. A significant proportion of this cohort had abnormal LCI with preserved FEV1, suggesting early subclinical small airway dysfunction, and supporting a role for MBW in the early identification of BOS.en_US
dc.description.sponsorshipThis work was co-funded by New Start, the heart and lung transplant charity based in Manchester (grant Alaloul 2017), and supported by the National Institute for Health Research (NIHR) Manchester Biomedical Research Centre.en_US
dc.language.isoenen_US
dc.publisherEuropean Respiratory Societyen_US
dc.relation.urlhttps://openres.ersjournals.com/content/5/4/00164-2019en_US
dc.subjectResearch Subject Categories::MEDICINEen_US
dc.subjectlung transplanten_US
dc.subjectobliterative bronchiolitisen_US
dc.subjectventilationen_US
dc.titleLung clearance index in detection of post-transplant bronchiolitis obliterans syndromeen_US
dc.typeArticleen_US
dc.identifier.eissn23120541
dc.contributor.departmentLung Function Laboratory, Manchester University NHS Foundation Trust, Manchester, UKen_US
dc.contributor.departmentCardiothoracic Transplant Unit, Manchester University NHS Foundation Trust, Manchester, UKen_US
dc.contributor.departmentFaculty of Biology, Medicine and Health, University of Manchester, Manchester, UKen_US
dc.contributor.departmentSchool of Human Sciences, University of Derby, Derby, UKen_US
dc.identifier.journalERJ Open Researchen_US
dcterms.dateAccepted2019-08-16
refterms.dateFOA2019-10-25T11:04:14Z
dc.author.detail786626en_US


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