r3journal.org
Imaging of Post–Lung Transplant Complications | AJR
A wide range of acute and chronic complications can develop after lung transplant. Primary graft dysfunction develops within days, characterized by diffuse alveolar damage, and predisposes patients to additional later complications. Surgical complications occur days to months after transplant and include hemorrhage, vascular stenosis or thrombosis, persistent pneumothorax or pleural effusions, and bronchial dehiscence or stenosis. Infection is a leading cause of mortality in the 1st year after transplant, often with nonspecific imaging findings. Chronic lung allograft dysfunction is a heterogeneous group of disorders characterized by spirometric decline that affects a high proportion of transplant patients within 5 years of transplant, with imaging findings that vary depending on if the underlying pathology is obstructive, restrictive, or mixed. In the same 5-year timeline, nearly one in four lung transplant patients develops malignancy, including cancer of the allograft and of other organs, such as posttransplant lymphoproliferative disease or melanoma. Certain primary lung diseases can recur after transplant, most notably sarcoidosis. Lung transplant is becoming an increasingly common treatment of end-stage lung disease, and radiologists must be familiar with the expected timeline and imaging findings of these major categories of lung transplant complications.
