Lung transplant complications can occur at variable time intervals following lung transplantation. It is essential for radiologists to be aware of specific complications as chest imaging is routinely used in the post-transplant assessment.
When reporting a postoperative chest radiograph or CT, it is mandatory to check the time interval since the transplantation and the indication for the transplantation.
These include:
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immediate and early postoperative period (first 24 hours to first week)
malpositioned tubes and lines
mechanical problems due to size mismatching between the donor lung and the recipient thoracic cage
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primary graft dysfunction - pulmonary edema following lung transplantation (reimplantation response)
corresponds to a transient ischemic/reperfusion injury that appears as a pulmonary edema in almost every patient during the first three days post-surgery 12
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acute lung transplant rejection
common process in the first 2 weeks after transplant with good prognosis
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hyperacute lung transplant rejection
fulminant syndrome that occurs immediately after the transplant and has a poor prognosis 9
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pleural complications 9
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intermediate period (1 week to 4 months)
Candida infection: first 3 months 9
CMV infection: between 1 and 6 months 9
Aspergillus infection: between 1 and 6 months 9
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late periods (after 4 months)
RSV infection
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chronic lung allograft dysfunction (CLAD)
bronchiolitis obliterans is probably due to chronic rejection 2 - see post-lung transplant bronchiolitis obliterans
upper lobe fibrosis is probably due to rejection 8,9
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