Post lung transplantation pulmonary edema
It is thought to occur relatively frequently (57% 1) after lung transplantation.
It is a form of non-cardiogenic pulmonary edema that occurs in pulmonary allografts in the first few days after transplantation. The exact pathogenesis is not well understood. Possible causes include 2,5:
- 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
- use of cardiopulmonary bypass during surgery (associated with increased incidence and severity)
It is not thought to be associated with a prolonged ischemia time, preoperative pulmonary hypertension, type of lung transplant, underlying lung disease, age, or sex of recipients.
Some report that opacities in this type of pulmonary edema being usually heterogeneous in nature and perihilar and lower lobe in distribution 2.
Treatment and prognosis
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.
Severe edema persists in up to 15% of cases which can then result in primary graft failure.
- 1. Khan SU, Salloum J, O'donovan PB et-al. Acute pulmonary edema after lung transplantation: the pulmonary reimplantation response. Chest. 1999;116 (1): 187-94. doi:10.1378/chest.116.1.187 - Pubmed citation
- 2. Marom EM, Choi YW, Palmer SM et-al. Reperfusion edema after lung transplantation: effect of daclizumab. Radiology. 2001;221 (2): 508-14. doi:10.1148/radiol.2212010381 - Pubmed citation
- 3. Ablett MJ, Grainger AJ, Keir MJ et-al. The correlation of the radiologic extent of lung transplantation edema with pulmonary oxygenation. AJR Am J Roentgenol. 1998;171 (3): 587-9. AJR Am J Roentgenol (abstract) - Pubmed citation
- 4. 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
- 5. 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