Post lung transplantation pulmonary oedema

Pulmonary oedema following lung transplantation is a type of acute pulmonary oedema that occurs as part of the pulmonary re-implantation response (PRR).

It is thought to occur relatively frequently (57% 1) after lung transplantation. 

It is a form of non-cardiogenic pulmonary oedema that occurs in pulmonary allografts in the first few days after transplantation.

The exact pathogenesis is not well understood. Possible causes include 2:

  • increased vascular permeability due to allograft ischemia and reperfusion
  • decreased surfactant production
  • interruption of lymphatic drainage 
  • uptake of calcium by cells 
  • free radical production 
  • possible vasoconstrictive effects of prostaglandin E2
Associations
  • use of cardiopulmonary bypass during surgery (associated with increased incidence and severity)

It is not thought to be associated with a prolonged ischaemia time, preoperative pulmonary hypertension, type of lung transplant, underlying lung disease, age, or sex of recipients. 

Plain radiograph

Some report that opacities in this type of pulmonary oedema being usually heterogeneous in nature and perihilar and lower lobe in distribution 2

It tends to worsen and peak a few days following transplantation, and then begin to resolve in most patients. It is typically treated with steroids and IL-2 antagonists such as daclizumab.

Complications

Severe oedema persists in up to 15% of cases which can then result in primary graft failure.

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Article information

rID: 17418
System: Chest
Section: Pathology
Tag: cases
Synonyms or Alternate Spellings:
  • Pulmonary oedema following lung transplantation
  • Pulmonary edema following lung transplantation
  • Post lung transplantation pulmonary edema
  • Post lung transplant pulmonary oedema

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