Acute lung transplant rejection
Acute lung transplant rejection is one of the post lung transplant complications. Histologically, it is defined as perivascular or peribronchiolar mononuclear inflammation and may affect up to 55% of lung transplant recipients within the first year after a transplant 2.
It can occur as several episodes and the first episode may occur early as 5 days after transplantation. The incidence is thought to peak at approximately 2 months post transplantation (with several episodes occurring) 3. After 6 months, acute rejection is an uncommon event.
HRCT / CT chest
While no single individual CT finding can be specific to the diagnosis 4, CT may show:
- ground-glass opacities - considered the most frequent finding 7
- interlobular septal thickening - without other signs of left ventricular failure
- nodular opacities 6
- pleural effusion - without other signs of left ventricular failure
- mild volume loss in the graft
Radiographic features may show a dramatic response to steroid therapy 5.
Acute lung rejection can be further complicated by subsequent development of bronchiolitis obliterans syndrome (BOS) which is a condition of progressive airflow obstruction that limits survival to only 50% at 5 years post transplantation 2.
Radiographic appearances can mimic 6
- reimplantation response - pulmonary oedema following lung transplantation
- pulmonary infection
- 1. Rao PN, Zeevi A, Snyder J et-al. Monitoring of acute lung rejection and infection by bronchoalveolar lavage and plasma levels of hyaluronic acid in clinical lung transplantation. J. Heart Lung Transplant. 1995;13 (6): 958-62. Pubmed citation
- 2; Martinu T, Chen DF, Palmer SM. Acute rejection and humoral sensitization in lung transplant recipients. Proc Am Thorac Soc. 2009;6 (1): 54-65. doi:10.1513/pats.200808-080GO - Free text at pubmed - Pubmed citation
- 3. Mangi AA, Mason DP, Nowicki ER et-al. Predictors of acute rejection after lung transplantation. Ann. Thorac. Surg. 2011;91 (6): 1754-62. doi:10.1016/j.athoracsur.2011.01.076 - Pubmed citation
- 4. Gotway MB, Dawn SK, Sellami D et-al. Acute rejection following lung transplantation: limitations in accuracy of thin-section CT for diagnosis. Radiology. 2001;221 (1): 207-12. doi:10.1148/radiol.2211010380 - Pubmed citation
- 5. Garg K, Zamora MR, Tuder R et-al. Lung transplantation: indications, donor and recipient selection, and imaging of complications. Radiographics. 1996;16 (2): 355-67. doi:10.1148/radiographics.16.2.8966293 - Pubmed citation
- 6. Ng YL, Paul N, Patsios D et-al. Imaging of lung transplantation: review. AJR Am J Roentgenol. 2009;192 (3_supplement): S1-13, quiz S14-9. doi:10.2214/AJR.07.7061 - Pubmed citation
- 7. Loubeyre P, Revel D, Delignette A et-al. High-resolution computed tomographic findings associated with histologically diagnosed acute lung rejection in heart-lung transplant recipients. Chest. 1995;107 (1): 132-8. Pubmed citation