Early detection and treatment of lung function decline post lung transplantation
Manchester University NHS Foundation Trust
Duration of Study in the UK
4 years, 0 months, 0 days
Lung transplantation involves major surgery, followed by intensive and life-long immune-suppression. Even with this, survival is disappointing and limited mainly by the development of chronic rejection. This process is called obliterative bronchiolitis (OB) and is characterised by narrowing and blockage of small airways in the lungs. One of the major challenges in dealing with OB is that we lack the tools to identify disease early. Standard lung function tests only detect disease that is already established, and other detection methods involve either radiation or invasive lung biopsy, which make them unsuitable for repeated routine use.
An alternative method of lung assessment involves measuring how efficiently gases mix in the lungs during normal relaxed breathing. The lung clearance index (LCI) calculated from this test has been shown in other diseases to be highly sensitive airway blockages. We believe that measuring LCI routinely in clinic will allow us to detect OB earlier than current standard tests. This is an observational study, meaning that we will not be directly changing patients’ treatments. However, we will be using a change in LCI at routine clinic review to direct more frequent follow-up or more detailed lung assessments (CT, bronchoscopy).
In addition to LCI, we will also use cutting-edge magnetic resonance imaging (MRI) technologies to investigate how OB develops. These MRI tests can be used to image gas mixing in the lungs, and do not use radiation. Finally, we will also perform new laboratory tests of lung rejection and infection on samples taken routinely from transplant patients. This will allow us to match the changes we measure in LCI or MRI to the disease processes in the airways. Early identification of OB in this way will allow us to alter immune-suppression in order to prevent disease progression, ultimately improving survival after lung transplant.
North of Scotland Research Ethics Committee 2
Date of REC Opinion
11 Sep 2020