Relationship Among Radiological Measurements of Anterior Mediastinal Fat and Outcomes of Lung Transplantation in Fibrotic Patients |
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| Affiliation: | 1. Department of Radiology, Guangzhou Universal Medical Imaging Diagnostic Center, Guangzhou, China;1. Departments of Oral and Maxillofacial Surgery, Portsmouth Hospitals NHS Trust, Portsmouth, PO6 3LY, UK;2. Histopathology, Portsmouth Hospitals NHS Trust, Portsmouth, PO6 3LY, UK;3. Clinical Oncology, Portsmouth Hospitals NHS Trust, Portsmouth, PO6 3LY, UK;1. Respiratory Function Laboratory and Critical Care Department, School of Medicine, Universidad de la República, Montevideo, Uruguay;2. Pathophysiology Department, School of Medicine, Universidad de la República, Montevideo, Uruguay;1. Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente (ICETA) da Universidade do Porto, Porto, Portugal;2. Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Porto, Portugal;3. Centro Hospitalar e Univrsitário do Porto (CHUP), Hospital Geral de Santo António (HGSA), Unidade de Broncologia, Serviço de Pneumologia, Porto, Portugal;4. CUF Infante Santo Hospital e CUF Descobertas Hospital, Faculdade de Ciências Médicas, Centro de Estudos de Doenças Crónicas (CEDOC), NOVA Medical School, Lisboa, Portugal |
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| Abstract: | ObjectiveLung transplantation (LT) for pulmonary fibrosis is related to higher mortality than other transplant indications. We aim to assess whether the amount of anterior mediastinal fat (AMF) was associated to early and long-term outcomes in fibrotic patients undergoing LT.MethodsRetrospective analysis of 92 consecutive single lung transplants (SLT) for pulmonary fibrosis over a 10-year period. AMF dimensions were measured on preoperative CT-scan: anteroposterior axis (AP), transverse axis (T), and height (H). AMF volumes (V) were calculated by the formula: AP × T × H × 3.14/6.According to the radiological AMF dimensions, patients were distributed into two groups: low-AMF (V < 20 cm3) and high-AMF (V > 20 cm3), and early and long-term outcomes were compared by univariable and multivariable analyses.ResultsThere were 92 SLT: 73M/19F, 53 ± 11 [14–68] years old. 30-Day mortality (low-AMF vs. high-AMF): 5 (5.4%) vs. 15 (16.3%), p = 0.014. Patients developing primary graft dysfunction within 72 h post-transplant, and those dying within 30 days post-transplant presented higher AMF volumes: 21.1 ± 19.8 vs. 43.3 ± 24.7 cm3 (p = 0.03) and 24.4 ± 24.2 vs. 56.9 ± 63.6 cm3 (p < 0.01) respectively. Overall survival (low-AMF vs. high-AMF) (1, 3, and 5 years): 85%, 81%, 78% vs. 55%, 40%, 33% (p < 0.001).Factors predicting 30-day mortality were: BMI (HR = 0.77, p = 0.011), AMF volume (HR = 1.04, p = 0.018), CPB (HR = 1.42, p = 0.002), ischaemic time (HR = 1.01, p = 0.009).Factors predicting survival were: AMF volume (HR = 1.02, p < 0.001), CPB (HR = 3.17, p = 0.003), ischaemic time (HR = 1.01, p = 0.001).ConclusionPreoperative radiological assessment of mediastinal fat dimensions and volumes may be a useful tool to identify fibrotic patients at higher risk of mortality after single lung transplantation. |
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| Keywords: | Lung transplantation Idiopathic pulmonary fibrosis Mediastinal fat Risk factors Outcomes Trasplante de pulmón Fibrosis pulmonar idiopática Grasa mediastínica Factores de riesgo Resultados |
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