Study design and patients
A retrospective cohort study of all lung transplant recipients (263 patients: 157 men,
106 women) at a single institution,
from January 2010 to January 2017. Data collection occurred between March 2017 and May 2017.
All transplant recipients were carefully follow-up at this institution,
setting up regular visits with the lung-transplant team. We subsequently reviewed the existing medical records and diagnostic imaging of all patients who underwent lung transplantation between the period specified.
The collected demographic features included sex,
age,
unilateral or bilateral transplantation and date of transplantation. We also recorded the date of neurological complication(s),
the date of death or last follow-up and the underlying disease motivating lung transplantation.
Imaging techniques and analyses
Imaging was performed on different CT and MRI scanners. Head CT was performed either with or without intravenous contrast medium. MRI brain studies were obtained at 1.5 T (Signa LX General Electric Medical Systems,
Waukesha,
WI) and 3 T (Achieva 3.0T Philips,
Best,
Netherlands) with a standard 8-channel head-coil and with standard protocols,
including axial T1-weighted,
axial T2-weighted,
axial FLAIR sequence,
axial diffusion-weighted,
coronal FLAIR and intravenously enhanced T1-weighted axial,
coronal and sagittal images.
The CT scans and MRIs were performed and evaluated by the Neuroradiology department staff. The imaging data and the diagnostic reports were collected and reviewed by a radiology resident and a senior faculty member with 15 years of neuroimaging experience.
Structural abnormalities on brain imaging were classified in the following categories:
- Cerebrovascular complications,
including intraparenchymal haemorrhage,
subarachnoid haemorrhage and acute/subacute ischaemic infarct.
- CNS infections.
- CNS malignancies.
- Drug toxicity with acute/subacute abnormality such as posterior reversible encephalopathy syndrome (PRES).
We excluded all the imaging abnormalities associated to chronic changes. All abnormalities were recorded with information on timing (in days after transplantation). Variables were summarized as median (continuous variables) and frequency (ordinal variables).