CT-Based Lung Size Matching in Delayed Chest Closure for Systemic Sclerosis Lung Transplantation

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2024-11-27 DOI:10.1111/ctr.70041

Jatin Singh, Xin Meng, Joseph K. Leader, John Ryan, Ernest G. Chan, Norihisa Shigemura, Chadi A. Hage, Pablo G. Sanchez, Jiantao Pu

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Abstract

Purpose

Delayed chest closure (DCC) during lung transplantation (LTx) is a controversial surgical approach that lacks research in systemic sclerosis (SSc) patients. We investigated outcomes, clinical risk factors, and CT-based lung size-matching parameters associated with DCC in SSc recipients.

Methods

This retrospective study included 92 SSc recipients (age 51 years ± 10, 56/92 (61.0%) females) who underwent bilateral LTx between 2007 and 2020. Of the recipients, 34.8% (32/92) underwent DCC. Recipient lung and chest cavity volumes were automatically computed from CT imaging using deep learning algorithms. Survival between groups was compared using Kaplan–Meier analysis. Multivariate logistic regression was used to identify risk factors and predict DCC occurrence using preoperative variables.

Results

Recipients who underwent DCC had longer total vent duration (p = 0.001), more use of postoperative mechanical support (p = 0.001), longer ICU length of stay (p = 0.008), and lower incidence of pneumonia post-operation (p = 0.031). No significant difference in survival was observed between DCC and PCC recipients at 30 days (p = 0.713), 90 days (p = 0.267), 1 year (p = 0.941), and 5 years (p = 0.651). Clinical risk factors for DCC included BMI > 30 kg/m² (p = 0.009), tracheostomy (p = 0.002), atrial fibrillation (p = 0.012), decreased preoperative FEV1/FVC (p = 0.013), and previous chest operation (p = 0.020). Two CT-based measurements of lung matching were significantly associated with DCC occurrence (p = 0.021 and 0.050). The regression model achieved a mean AUC of 0.82 (0.70, 0.94) in retrospectively predicting DCC occurrence.

Conclusion

SSc recipients undergoing DCC have similar survival rates but experience more complications than PCC recipients. Clinical risk factors and CT-based size matching can be leveraged to predict DCC pre-transplant.

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基于 CT 的肺大小匹配在系统性硬化肺移植延迟胸腔闭合中的应用

目的：肺移植（LTx）过程中的延迟胸腔闭合（DCC）是一种有争议的手术方法，对系统硬化症（SSc）患者缺乏研究。我们调查了SSc受者中与DCC相关的结果、临床风险因素和基于CT的肺大小匹配参数：这项回顾性研究纳入了 2007 年至 2020 年间接受双侧 LTx 的 92 名 SSc 受者（年龄 51 岁 ± 10，女性 56/92 (61.0%)）。其中 34.8%（32/92）的受者接受了 DCC。受者的肺和胸腔容积是利用深度学习算法通过 CT 成像自动计算得出的。采用卡普兰-梅耶尔分析法比较各组间的生存率。采用多变量逻辑回归确定风险因素，并利用术前变量预测DCC的发生：结果：接受 DCC 的受者总通气时间较长（p = 0.001），术后使用机械支持较多（p = 0.001），重症监护室住院时间较长（p = 0.008），术后肺炎发生率较低（p = 0.031）。在 30 天（p = 0.713）、90 天（p = 0.267）、1 年（p = 0.941）和 5 年（p = 0.651）的存活率方面，DCC 和 PCC 受试者无明显差异。DCC 的临床风险因素包括 BMI > 30 kg/m2 (p=0.009)、气管切开术 (p=0.002)、心房颤动 (p=0.012)、术前 FEV1/FVC 降低 (p = 0.013) 和既往胸部手术 (p=0.020)。两种基于 CT 的肺匹配测量结果与 DCC 的发生显著相关（p = 0.021 和 0.050）。回归模型在回顾性预测 DCC 发生率方面的平均 AUC 为 0.82 (0.70, 0.94)：结论：接受DCC治疗的SSc受者生存率相似，但并发症发生率高于PCC受者。临床风险因素和基于CT的大小匹配可用于预测移植前的DCC。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.