Lung ultrasound characteristics of lung transplant recipients

SESSION TITLE: Transplantation Posters 1 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: Point-of-care lung ultrasonography (LUS) is often utilized for the rapid evaluation of undifferentiated thoracic disorders in the critically ill. It has not been studied well in lung transplantation where there are key anatomic and pathophysiologic differences in addition to a myriad of potential complications. Post-transplant monitoring includes routine labs, pulmonary function tests, chest x-rays, and bronchoscopy. Despite the known high sensitivity and specificity of LUS, it has not yet been routinely implemented in this setting. We sought to identify predominant characteristics seen with LUS in lung transplant recipients in order to form the landscape for contextualized use. METHODS: LUS was utilized to supplement our clinical exam in the outpatient follow up of lung transplant recipients at MUSC Charleston between 09/2022-01/2023. LUS was performed using the Butterfly iQ+ handheld ultrasound (Butterfly Network, Inc) with sequential assessment of bilateral zones per the commonly used bedside lung ultrasound in emergency (BLUE) protocol. Left and right chest wall zones include: upper anterior (Zone 1), lower anterior (Zone 2), and posterolateral (Zone 3). LUS images were retrospectively reviewed with detailing of findings through a REDCap survey including lung sliding, A-lines, B-lines, >/= 3 B-lines (sonographic equivalent to radiographic alveolar-interstitial syndrome), B3 lines (B-lines 3mm or less apart representing an alveolar process), B7 lines (B-lines 7mm or greater apart representing thickened interlobular septa), consolidation, effusion and overall BLUE profile (A, A’, B, B’, A/B, or C). RESULTS: At time of submission, 50 lung transplant recipients underwent LUS and 2 were excluded given history of a single lung transplant. Average time from transplant was 4 years and 4 months. LUS of the total zones (6 zones per patient, N=288) demonstrated lung sliding (99.6%, n=287), A-lines (89.6%, n=258), B-lines (19.8%, n=57), >/= 3 B-lines (8.3%, n =24), B3 lines (6.9%, n=20), B7 lines (1.4%, n=4), consolidation (3.1%, n=8), and effusion (3.8%, n=11). Overall prevalence of B-lines was 68.8% (n=33) among patients, with 48.5% (n=16) demonstrating >/= 3 B-lines. BLUE profiles identified were A (62.5%, n=30), A/B (25%, n= 12), B (10.4%, n=5), and C (2.1%, n=1). CONCLUSIONS: This investigation highlights an array of ultrasound findings in lung transplant recipients, including a noteworthy prevalence of B-lines among our sampled cohort. Of those with multiple B-lines, B3 lines were more common than B7 lines, consistent with an alveolar filling process. These findings may be representative of subclinical edema that may be underappreciated. Further study is needed to better identify its significance. CLINICAL IMPLICATIONS: Lung ultrasonography may be an important adjunctive tool in the examination and surveillance of lung transplant recipients. DISCLOSURES: No relevant relationships by Amit Chopra No relevant relationships by John Huggins, value=Honoraria Removed 12/05/2022 by John Huggins, source=Web Response No relevant relationships by John Huggins, value=Grant/Research Removed 12/05/2022 by John Huggins, source=Web Response No relevant relationships by John Huggins, value=Grant/Research Support Removed 12/05/2022 by John Huggins, source=Web Response No relevant relationships by John Huggins, value=Grant/Research Support Removed 12/05/2022 by John Huggins, source=Web Response No relevant relationships by John Huggins, value=Grant/Research Support Removed 12/05/2022 by John Huggins, source=Web Response No relevant relationships by Luca Paoletti No relevant relationships by Ravi Patel No relevant relationships by Timothy Whelan No relevant relationships by Amy Wisse