Acute lung transplant rejection is one of the early post lung transplant complications.
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.
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.
While no single individual CT finding can be specific to the diagnosis 4,8, CT may show:
- ground-glass opacities: considered the most frequent finding 7 and, when absent, it almost excludes acute rejection 8
- interlobular septal thickening
- pleural effusion
- nodular opacities 6
- mild volume loss in the graft
Radiographic features may show a dramatic response to steroid therapy 5,8.
Treatment and prognosis
Acute lung rejection can be further complicated by the 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
- especially when consolidative changes are present
- 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
- 8. Krishnam MS, Suh RD, Tomasian A, Goldin JG, Lai C, Brown K, Batra P, Aberle DR. Postoperative complications of lung transplantation: radiologic findings along a time continuum. (2007) Radiographics : a review publication of the Radiological Society of North America, Inc. 27 (4): 957-74. doi:10.1148/rg.274065141 - Pubmed