ACUTE REJECTION DIAGNOSED WITH COMPUTED-TOMOGRAPHY IN A PORCINE EXPERIMENTAL LUNG TRANSPLANTATION MODEL

The role of computed tomography (CT) in the diagnosis of acute rejecti on was studied in an experimental lung transplantation model, with 15 left lung allotransplantations and six autotransplantations performed on piglets weighing 16-24 kg. There were 31 episodes of acute rejectio n. In the allotransplantation group the development of acute rejection was monitored 115 times with CT, transbronchial biopsy (TBB) and bron choalveolar lavage (BAL). The stages of acute rejection were 1) ill-de fined centrilobular micronodules or minimal patchy ground-glass opacit ies, 2) dense, small-nodular infiltration or extensive ground-glass op acities, and bronchial wall thickening, 3) lung volume loss and dense, patchy ground-glass opacities and 4) consolidation of the lung. In th e autotransplantation group monitoring was done 42 times. After allotr ansplantation, TBB and BAL suggested rejection 60 times and infection 23 times. CT had 86.7% sensitivity and 85.6% specificity. During the f irst month these figures were, respectively, 71.4% and 84.2%. Rising h istologic grade was associated with increasing stage of acute rejectio n on CT, which thus proved to be a sensitive and specific method for d iagnosing acute rejection of lung transplant.