Comparison of chest radiograph scoring to lung weight as a quantitative index of pulmonary edema in organ donors

Ware LB, Neyrinck A, O’Neal HR, Lee JW, Landeck M, Johnson E, Calfee CS, Matthay MA and the California Transplant Donor Network. Comparison of chest radiograph scoring to lung weight as a quantitative index of pulmonary edema in organ donors. Abstract: Quantification of the degree of pulmonary edema in organ donors is useful for assessing the clinical severity of pulmonary edema, determining response to therapy, and as an endpoint for therapeutic trials. Currently, there is no accurate non‐invasive method for assessing the degree of pulmonary edema. We tested the performance of a four‐quadrant chest radiographic scoring system compared to quantification of pulmonary edema by excised lung weight in 84 donors whose lungs were not used for transplantation. Chest radiographs were taken 3.6 ± 3.0 h prior to organ procurement and were scored by two of the authors. Lungs were excised without perfusion and individually weighed. The chest radiographic scoring system had good performance: correlation between total radiographic score and total lung weight of 0.61, p < 0.001. Performance of the scoring system was improved when chest radiographs with atelectasis were excluded (r = 0.79, p < 0.001). The area under the receiver operator characteristic curve for the detection of moderate pulmonary edema (total lung weight >1000 g) was 0.80. This chest radiographic scoring system may potentially be used to assess the clinical severity of pulmonary edema and may be useful as part of the evaluation of donors for suitability for lung transplantation.