Lung Ultrasound as a Promising Diagnostic Tool for Primary Graft Dysfunction after Lung Transplantation

Abstract

Purpose The aim of the study was to evaluate whether the quantification of B-lines via lung ultrasound after lung transplantation is feasible and correlates with the diagnosis of primary graft dysfunction.

Methods Following lung transplantation, patients underwent daily lung ultrasound on postoperative days 1–3. B-lines were quantified by an ultrasound score based on the number of single and confluent B-lines per intercostal space, using a four-region protocol. The ultrasound score was correlated with the diagnosis of primary graft dysfunction. Furthermore, correlation analyses and receiver operating characteristics analyses taking into account ultrasound score, chest radiographs, and PaO2/FiO2 ratio were performed.

Results A total of 32 patients (91 ultrasound measurements) were included, whereby 10 were diagnosed with primary graft dysfunction. The median B-line score was 5 [IQR: 4, 8]. There was a significant correlation between B-line score and the diagnosis of primary graft dysfunction (r = 0.59, p < 0.001). A significant correlation could also be seen between chest X-rays and primary graft dysfunction (r = 0.34, p = 0.008), but the B-line score showed superiority over chest X-rays with respect to diagnosing primary graft dysfunction in the receiver operating characteristics curves with an area under the curve value of 0.921 versus 0.708. There was a significant negative correlation between B-line score and PaO2/FiO2 ratio (r = –0.41, p < 0.001), but not between chest X-rays and PaO2/FiO2 ratio (r = –0.14, p = 0.279).

Conclusion The appearance of B-lines correlated well with primary graft dysfunction and outperformed chest radiographs.

Zusammenfassung

Ziel In der Studie wurde untersucht, ob die Quantifizierung von B-Linien mittels Lungenultraschall nach Lungentransplantation möglich ist und mit der Diagnose eines primären Transplantatversagens korreliert.

Material und Methode Bei Patienten nach Lungentransplantation wurde an den postoperativen Tagen 1–3-mal täglich ein Lungenultraschall durchgeführt. B-Linien wurden mittels Ultraschall-Score quantifiziert. Dieser wurde mit der Diagnose eines primären Transplantatversagens korreliert. Zusätzlich wurden Korrelations- und Receiver-Operating-Characteristics-Analysen unter Berücksichtigung von Ultraschall-Scores, Röntgen-Thorax-Bildern und PaO2/FiO2-Ratio durchgeführt.

Ergebnisse 32 Patienten (91 Ultraschalluntersuchungen) wurden eingeschlossen, von denen 10 ein primäres Transplantatversagen aufwiesen. Der mediane B-Linien-Score betrug 5 [IQR: 4, 8]. Es bestand eine signifikante Korrelation zwischen dem B-Linien-Score und der Diagnose eines primären Transplantatversagens (r = 0,59, p < 0,001) sowie zwischen Röntgenbildern und primärem Transplantatversagen (r = 0,34, p = 0,008). Der B-Linien-Score war bei der Diagnose des primären Transplantatversagens den Röntgenaufnahmen in den Receiver-Operating-Characteristics-Kurven mit einer Fläche unter der Kurve von 0,921 gegenüber 0,708 überlegen. Es bestand eine signifikante negative Korrelation zwischen dem B-Line-Score und dem PaO2/FiO2-Verhältnis (r = –0,41, p < 0,001), jedoch nicht zwischen Röntgenbildern und dem PaO2/FiO2-Verhältnis (r = –0,14, p = 0,279).

Schlussfolgerung Das Auftreten von B-Linien korrelierte gut mit der Diagnose des primären Transplantatversagens und zeigte sich gegenüber den Röntgenbildern überlegen.

Keywords

Chest - Point of care - Lung Ultrasound - B-lines - Primary Graft Dysfunction

Publication History

Received: 16 June 2022

Accepted after revision: 02 January 2023

Article published online:
28 February 2023

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