COMPARISON OF SPECT LUNG PERFUSION WITH TRANSBRONCHIAL LUNG-BIOPSY AFTER LUNG TRANSPLANTATION

The objective of this study was to evaluate the potential role for sin gle photon-emission computed tomography (SPECT) using technetium 99m-m acroaggregated albumin for diagnosing rejection in lung transplant pat ients. SPECT results were compared with those obtained from transbronc hial biopsy (TBB) in patients undergoing bronchoscopy during routine s urveillance and in cases of clinical, radiographic, or physiologic sus picion of lung rejection. This prospective, nonrandomized study was co nducted by the Marseille Lung Transplant Group, Marseille University H ospital South. It included 26 lung transplant recipients (19 double-lu ng, four single-lung, and three heart-lung). For each patient, SPECT l ung perfusion was performed before TBB as part of routine surveillance protocol and when clinically indicated. Routine surveillance included TBB at 1, 3, 6, 9, and 12 months and every 6 months thereafter. SPECT was always performed within the 24 h preceding TBB. Whenever the SPEC T was abnormal, biopsies were obtained from an area corresponding to a region of hypoperfusion. Results of the study were based on 79 paired SPECT and TBB obtained from 26 patients. Concordance between SPECT an d biopsy occurred in 71 instances (89.9%). Among 54 cases of abnormal SPECT, TBB was also abnormal in 47 (87.0%), with lung rejection being the abnormality in 23 (46%). For pairs performed as part of the routin e surveillance protocol (61 pairs), clinically silent lung rejection w as diagnosed in 16 (26.2%). SPECT was abnormal in 15 of 16 instances a nd normal in only one; this patient had minimal rejection that resolve d without treatment. These results suggest that SPECT lung perfusion s cintigraphy may be useful for screening asymptomatic lung transplant r ecipients for rejection. When abnormal, SPECT may serve to guide TBB.