BACKGROUND: The Lung Volume Reduction Coil Treatment in Patients With Emphysema (RENEW) trial reported improvements in quality of life, pulmonary function, and exercise performance following endobronchial coil treatment. OBJECTIVES: The purpose of this post hoc analysis was to identify baseline predictors, including quantitative CT measures, that identify patients most likely to significantly benefit from endobronchial coil therapy. METHODS: Quantitative CT analysis by an independent radiology laboratory and a qualitative evaluation by five blinded experts of the baseline thoracic CT imaging were performed. Univariate and multivariate logistic regression analyses were performed to elucidate characteristics associated with clinical response. RESULTS: In total, 125 patients underwent coil treatment and had evaluable 12-month follow-up results. Of these, 78 patients received treatment of lobes with the highest emphysematous destruction determined by quantitative CT analysis (quantitative visual match [QVM]+), and 47 received treatment in at least one lobe that was not the most destroyed (QVM-). From the 78 patients with QVM+ treatment, a subgroup of 50 patients (64%) was identified with baseline residual volume > 200% predicted, emphysema score > 20% low attenuation area, and absence of airway disease. In this subgroup, greater lobar residual volume reduction in the treated lobes was achieved, which was associated with significant mean +/- SE improvement in FEV1 (15.2 +/- 3.1%), St. George's Respiratory Questionnaire (-12 +/- 2 points), and residual volume (-0.57 +/- 0.13 L). DISCUSSION: This post hoc analysis found that both significant hyperinflation (residual volume >= 200% predicted) and CT analysis are critical for patient selection and treatment planning for endobronchial coil therapy. Quantitative CT analysis is important to identify optimal lobar treatment and to exclude patients with insufficient emphysema (< 20% low attenuation area), whereas visual assessment identifies patients with signs of airway disease associated with worse outcomes.

Poor esophageal motility and impaired clearance of a swallowed bolus or refluxed gastric contents are risk factors for the development of chronic lung allograft dysfunction (CLAD). A severe motility disorder may render patients with end-stage lung disease ineligible for lung transplantation. Transelectrical stimulation (TES) has been shown to improve the motility of visceral smooth muscle. We hypothesized that the use of TES in patients with end-stage lung disease, either pre- or post-transplant, could result in an objective improvement in esophageal motility.

Purpose The purpose of this study was to determine if thrombocytosis (>450 K/microL) predicted the development of acute rejection or infection on diagnostic bronchoscopy in the first 30 days post lung transplant. Methods and Materials The study was performed at a single center and consisted of a cohort of 333 lung transplant recipients from January 2000 to December 2010. Acute rejection was graded using standard ISHLT criteria. The transbronchial biopsy results taken during the first 30 days post transplant were correlated to the corresponding platelet count. A retrospective chart review at that time also determined if any pulmonary infections were present as evidenced by positive bronchoalveolar lavage, blood cultures, and radiographic abnormalities. Comparisons were made utilizing independent group T test and logistic regression. Results A platelet count greater than 450 K/microL was highly predictive of acute rejection and/ or underlying pneumonia with a p value of Conclusions These results confirm that thrombocytosis acts as acute phase reactant and is a predictor of either acute rejection or infection in the first 30 days post lung transplant. It should hence be used as a predictor for the impending development or occult presence of rejection or infection in this population and prompt further investigation.