Novel Magnetic Resonance Imaging for Assessment of Bronchial Stenosis in Lung Transplant Recipients.

Bronchial stenosis in lung transplant recipients is a common disorder that adversely affects clinical outcomes. It is evaluated by spirometry, CT scanning, and bronchoscopy with significant limitations. We hypothesize that MRI using both ultrashort echo time (UTE) scans and hyperpolarized (HP) 129 Xe gas can offer structural and functional assessment of bronchial stenosis seen after lung transplantation. Six patients with lung transplantation-related bronchial stenosis underwent HP 129 Xe MRI and UTE MRI in the same session. Three patients subsequently underwent airway stent placement and had repeated MRI at 4-week follow-up. HP 129 Xe MRI depicted decreased ventilation distal to the stenotic airway. After airway stent placement, MRI showed that low-ventilation regions had decreased (35% vs. 27.6%, p = 0.006) and normal-ventilation regions had increased (17.9% vs. 27.6%, p = 0.04) in the stented lung. Improved gas transfer was also seen on 129 Xe MRI. There was a good correlation between UTE MRI and independent bronchoscopic airway diameter assessment (Pearson correlation coefficient = 0.92). This pilot study shows that UTE and HP 129 Xe MRI are feasible in patients with bronchial stenosis related to lung transplantation and may provide structural and functional airway assessment to guide treatment. These conclusions need to be confirmed with larger studies.

Significance of and risk factors for the development of central airway stenosis after lung transplantation.

Central airways stenosis (CAS) after lung transplant is a poorly understood complication. Objectives of this study were to determine if CAS was associated with chronic rejection or worse survival after transplant as well as to identify factors associated with CAS in a large cohort of lung transplant recipients. Lung transplant recipients transplanted at a single center were retrospectively reviewed for the development of CAS requiring airway dilation. A total of 467 subjects met inclusion criteria with 60 (13%) of these developing CAS requiring intervention. Of these 60 recipients, 22 (37%) had resolution of CAS with bronchoplasty alone, while 32 (53%) ultimately required stent placement. CAS that required intervention was not a risk factor for the development of bronchiolitis obliterans syndrome or worse overall survival. Significant risk factors for the subsequent development of CAS in a time-dependant multivariable model were pulmonary fungal infections and the need for postoperative tracheostomy. While CAS was not associated with BOS or worse survival, it remains an important complication after lung transplant with potentially preventable risk factors.

Effects of hypoxia and toxicant exposure on adenylate energy charge and cytosolic ADP concentrations in abalone.

Many studies have used adenylate energy charge (AEC) as an index of an organism's metabolic state under conditions of imposed stress, either through natural or xenobiotic stressors. AEC is a linear measure of the ratio of ATP concentration to total adenylate concentration, which ranges in value from 1 in the fully charged state to 0. Paradoxically, high values of AEC are often associated with high toxicant exposures, and low AEC values with low exposures. These discrepancies may be caused by the inability of AEC measurements to adequately evaluate cytosolic adenylate concentrations, which are the critical parameters in enzymatic regulation. Consequently, the goal of this study was to compare AEC values, as measured by high performance liquid chromatography (HPLC), to free adenosine diphosphate (ADPfree) concentrations, as measured using the arginine kinase equilibrium reaction and in vivo 31P-NMR, in red abalone (Haliotis rufescens) in response to either hypoxia or toxicant (pentachlorophenol, or sodium azide) exposure. AEC values remain essentially constant when compared with control animals during periods of stress exposure and recovery. In contrast, calculated ADPfree concentrations are approximately a third of those determined by HPLC and nearly double in response to stress exposure. The physiologic importance of this response is demonstrated by increases in ATP formation via arginine kinase. These results are discussed in light of the pertinent mammalian literature.