Evaluation of anastomotic diameter in lung transplant: Comparing bronchofibroscopy with multiplanar reconstructed thoracic computed tomography

Introduction: Lung transplant (LT) is therapeutic option for patients (pts) with end-stage lung disease. However it is still associated with many complications, namely airway complications (AC). Recently, a grading system for central AC after lung transplantation was published, known as the MDS classification – corresponding to macroscopic aspect (M), diameter (D) and appearance of the sutures (S) of the anastomosis. Objectives: Compare the anastomosis diameter according to MDS classification assessed with bronchofibroscopy (BF) and multiplanar reconstructed thoracic computed tomography (CT) in a series of pts submitted to LT in our center between Jan/2012 and Dec/2014. Methods: Retrospective analysis of BF reports and correspondent CT images (max 30 days difference). The anastomosis diameter was classified according to MDS classification as D0: normal to fixed reduction up to 33%; D1: malacia greater than 50%; D2: stenosis from 33% to 66% and D3: stenosis greater than 66%. Results: One hundred and thirty exams (performed 15 days to 34 months after LT) were analyzed and the results were as in table 1. No significant correlation between BF and CT results was found. Moreover, when compared to BF (gold standard), the CT sensitivity in the assessment of significant stenosis (D1 – D3) was 17% and specificity 86%. Conclusions: BF remains an indispensable technique in the evaluation of airway complications in LT. However, due to his high specificity, CT can be useful in diagnosing significant stenosis.