Ventilation and perfusion scintigraphy after lung transplantation

Study objective. Evaluation of the possibilities of ventilation and perfusion scintigraphy in detecting functional disorders and determining the severity of lung damage that may occur after organ transplantation.
Material and methods. The study included 27 patients after bilateral lung transplantation; mucoviscidosis was the main cause of terminal respiratory failure in most cases (19 patients; 77.8%). The ventilation scintigraphy was performed with ^99mTc-pentatech using a nebulizer, and the perfusion scintigraphy was performed with ^99mТс-albumin macroaggregate. The investigations were performed on Infinia II and Discovery 670 NM/CT single-photon emission tomographs (GE, USA).
Results. Changes in the quantitative parameters of ventilation and perfusion scintigraphy in patients after lung transplantation were studied. When analyzing the results of radionuclide studies, we identified a restoration of function after lung transplantation, and the appearance of disorders with the development of complications in the early (up to 4 months) and later (more than one year) periods after bilateral lung transplantation.
Conclusion. The study has shown that the radionuclide method has wide possibilities for assessing the ventilation and perfusion functions in patients after lung transplantation, helping in the differential diagnosis of obliterating bronchiolitis and graft vascular sclerosis, in assessing the nature of alveolar-capillary diffusion disorders, and determining the extent of functional abnormalities in every individual patient. Monitoring the function of transplanted lungs using scintigraphy allows separate monitoring of ventilation and perfusion changes, which is important for the choice of treatment tactics.

1. Nathan SD, Shlobin OA, Weir N, Ahmad S, Kaldjob JM, Battle E, et al. Long-term course and prognosis of idiopathic pulmonary fibrosis in the new millennium. Chest. 2011;140(1):221– 229. PMID: 21729893 https://doi.org/10.1378/chest.10-2572

2. Jo HE, Glaspole I, Grainge C, Goh N, Hopkins PM, Moodley Y, et al. Baseline characteristics of idiopathic pulmonary fibrosis: analysis from the Australian idiopathic pulmonary fibrosis registry. Eur Respir J. 2017;49(2). pii:1601592. PMID: 28232409 https://doi.org/10.1183/13993003.01592-2016

3. Mahajan AK, Folch E, Khandhar SJ, Channick CL, Santacruz JF, Mehta AC, et al. The diagnosis and management of airway complications following lung transplantation. Chest. 2017;152(3):627– 638. PMID: 28274791 https://doi.org/10.1016/j.chest.2017.02.021

4. Hoechter DJ, von Dossow V. Lung transplantation: from the procedure to managing patients with lung transplantation. Curr Opin Anaesthesiol. 2016;29(1):8–13. PMID: 26545145 https://doi.org/10.1097/ACO.0000000000000268

5. Sulania A, Sachdeva S, Jha D, Kaur G, Sachdeva R. Organ donation and transplantation: An updated overview. MAMC J Med Sci. 2016;2(1):18–27. https://doi.org/10.4103/2394-7438.174832

6. Fine NM, Kushwaha SS. Recent advances in mammalian target of rapamycin inhibitor use in heart and lung transplantation. Transplantation. 2016;100(12):2558–2568. PMID: 27495747 https://doi.org/10.1097/TP.0000000000001432

7. Jakubec P, Žurková M, Hajdová L, Křenková A, Kolek V. The complications after lung transplantation. Vnitr Lek. 2018;63(11):848-859. PMID: 29303288

8. Boytsova EV, Ovsyannikov DYu. Postinfectious obliterans bronchiolitis in children. Children infections. 2014;13(2):24–28. (In Russ.). https://doi.org/10.22627/2072-8107-2014-13-2-24- 28

9. Potestio C, Jordan D, Kachulis B. Acute postoperative management after lung transplantation. Best Pract Res Clin Anaesthesiol. 2017;31(2):273–284. PMID: 29110799 https://doi.org/10.1016/j.bpa.2017.07.004

10. Costa J, Benvenuto LJ, Sonett JR. Long-term outсomes and management of lung transplant recipients. Best Pract Res Clin Anaesthesiol. 2017;31(2):285–297. PMID: 29110800 https://doi.org/10.1016/j.bpa.2017.05.006

11. Leal S, Sacanell J, Riera J, Masclans JR, Rello J. Early postoperative management of lung transplantation. Minerva Anestesiol. 2014;80(11):1234–1245. PMID: 24518214

12. Porhownik NR. Airway complications post lung transplantation. Curr Opin Pulm Med. 2013;19(2):174–180. PMID: 23287284 https://doi.org/10.1097/MCP.0b013e32835d2ef9

13. Gillespie M, Rizzolo D. A systemsbased approach to patient care after liver transplantation. JAAPA. 2018;31(1):14– 19. PMID: 29227319 https://doi.org/10.1097/01.JAA.0000527694.68417.0a

14. Kao CC, Parulekar AD. Postoperative management of lung transplant recipients. J Thorac Dis. 2019;11(Suppl 14):S1782–S1788. PMID: 31632755 https://doi.org/10.21037/jtd.2019.05.60

15. Gautier SV, Golovinskiy SB, Poptsov VN, Tsiroulnikova OM, Nechaev NB, Spirina EA, et al. First pediatric bilateral lobar lung transplantation for cystic fibrosis in Russian Federation. Russian Journal of Transplantology and Artificial Organs. 2017;19(4):11–15. (In Russ.). https://doi.org/10.15825/1995-1191-2017-4-11-15

16. Gottschalk A, Sostman HD, Coleman RE, Juni JE, Thrall J, McKusick KA, et al. Ventialation-perfusion scintigraphy in the PIOPED study. Part II. Evaluation of the scintigraphic criteria and interpretations. J Nucl Med. 1993;34(7):1119–1126. PMID: 8315488

17. Rubin MP, Kuleshova OD, Chechurin RE. Radionuklidnaya ventilyatsionnaya aerozol’naya stsintigrafiya legkikh: metodika issledovaniya i interpretatsiya rezul’tatov. Radiology – Practice. 2002;(1):19–24. (In Russ.).

18. Lishmanov YuB, Krivonogov NG, Ageyeva TS, Dubodelova AV, Mishuchstina EL. Basic parameters of pulmonary ventilation-perfusion scintigraphy in healthy individuals. Journal of radiology and nuclear medicine. 2007;(6):34–39. (In Russ.)

19. Migunova EV, Kudryashova NE, Nikitina OV, Beresneva EA, Goldina IM, Zabavskaya OA, et al. Assessment of the effectiveness of thrombolytic therapy of pulmonary tromboembolism by lung perfusion scanning. Molecular medicine. 2013;(4):46–50. (In Russ.).

20. Tromboemboliya legochnoy arterii. Metody diagnostiki: ucheb.-metod. posobiye. Moscow: N.V. Sklifosovsky Research Institute for Emergency Medicine Publ., 2014. (In Russ.).

21. Savelyev VS, Yablokov EG, Kiriyenko AI. Massivnaya emboliya legochnoy arterii. Moscow: Meditsina Publ., 1990. (In Russ.).

22. Pistolesi M, Lavorini F, Allescia G., Miniati M. Diagnostic strategies for suspected pulmonary embolism. In: Bankier AA. Imaging. European respiratory monograph. 2004. Monograph 30. Ch. 6. p. 89–105. https://doi.org/10.1183/1025448x.00030006

23. Avdeyev SN. Novyye vozmozhnosti v terapii bronkhiolitov. The Journal of Practical Pulmonology (Atmosphere. Pulmonology and Allergology). 2009;(4):12– 18. (In Russ.).