Detecting Acute Lung Rejection and Infection Following Heart-Lung Transplantation: PATIENTS AND METHODS
Spirometer
The pocket-sized spirometer (Micro-medical Ltd, Rochester, Kent, England) (Fig 1), the prototype of which has been fully described in a previous report, measures the FEV, and FVC by means of a turbine volume transducer. The turbine drives a low- inertia vane that, during forced expiration, reflects infrared light from an enclosed source onto a sensor to generate electrical pulses. These are then proportionately computed into FEV, and FVC. The accuracy of the spirometer is within 2 percent.
The subject blows through the mouthpiece and by means of a switch, the FEV, or FVC is read off a digital display unit. The measurements are registered in liters at body temperature and pressure saturated with water vapor (BTPS).
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The spirometers are factory calibrated. However, the calibration was checked regularly by connecting the spirometer in a series with a Vitalograph spirometer (Vitalograph U.K. Ltd, Kent, England) and comparing the two measurements of spirometric volumes.
Ibtients
Fifteen HLT recipients, six male and nine female, 12 to 51 years old, were prospectively studied over a period of six months. They were supplied with the pocket-sized turbine spirometer, taught how to use this instrument, and requested to record the best of three attempts twice daily at home. The record was reviewed by the physician during each clinic visit and the data were entered into a data file on a microcomputer flandon).
Figure 1. The pocket-sized turbine spirometer that measures 17 x 6 x 5.2 cm, weights 2(K) g, and runs on a 9-V PP3 battery.
Transbronchial biopsy through a fiberoptic bronchoscope, the technique of which lias been fully described elsewhere, was performed routinely when the patient was symptom free at three, six, 12, and 24 months after transplantation, on the development of respiratory symptoms or when the roentgenograph was abnormal.
In addition, laboratory measurements of lung function, including spirometry, single breath gas transfer for carbon monoxide (Deo), and total lung capacity (TLX’) were carried out in each patient at routine assessments and when they had respiratory symptoms. erectalis 20
Acute lung rejection was diagnosed by histologic findings from the transbronchial biopsy specimen. Characteristically there are perivascular infiltrates consisting of large pvroninophilic, ie, im- munoblastic, lymphocytes. The diagnosis was confirmed if in the absence of infection the patient s symptoms, signs, roentgenogram, or lung function improved with augmented immunosuppression. Opportunistic and bacterial lung infections were diagnosed histologically, serologically, and by culture of tissue or lavage specimens.
