Pulmonary edema following lung transplantation is a type of non-cardiogenic acute pulmonary edema that occurs as part of the pulmonary re-implantation response (PRR).
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Epidemiology
It is thought to occur relatively frequently (57% 1) after lung transplantation.
Pathology
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
Associations
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.
Radiographic features
Plain radiograph
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.
Complications
Severe edema persists in up to 15% of cases which can then result in primary graft failure.
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