Acute lung transplant rejection

Last revised by Bruno Di Muzio on 7 May 2018

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:

Radiographic features may show a dramatic response to steroid therapy 5,8.

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:

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