European Radiology

, Volume 27, Issue 7, pp 2810–2817 | Cite as

Restrictive allograft syndrome after lung transplantation: new radiological insights

  • Adriana Dubbeldam
  • Caroline Barthels
  • Johan Coolen
  • Johny A. Verschakelen
  • Stijn E. Verleden
  • Robin Vos
  • Geert M. Verleden
  • Walter De Wever



To describe the CT changes in patients with restrictive allograft syndrome (RAS) after lung transplantation, before and after clinical diagnosis.


This retrospective study included 22 patients with clinical diagnosis of RAS. Diagnosis was based on a combination of forced expiratory volume (FEV1) decline (≥20 %) and total lung capacity (TLC) decline (≥10 %). All available CT scans after transplantation were analyzed for the appearance and evolution of lung abnormalities.


In 14 patients, non-regressing nodules and reticulations predominantly affecting the upper lobes developed an average of 13.9 months prior to the diagnosis of RAS. Median graft survival after onset of non-regressing abnormalities was 33.5 months, with most patients in follow-up (9/14). In eight patients, a sudden appearance of diffuse consolidations mainly affecting both upper and lower lobes was seen an average of 2.8 months prior to the diagnosis of RAS. Median graft survival was 6.4 months after first onset of non-regressing abnormalities, with graft loss in most patients (6/8).


RAS has been previously described as a homogenous group. However, our study shows two different groups of RAS-patients: one with slow progression and one with fast progression. The two groups show different onset and progression patterns of CT abnormalities.

Key points

RAS is the newest discovered form of chronic lung allograft dysfunction (CLAD).

RAS is not a homogenous group, as survival varies greatly between patients.

In this study, we see two different CT onset and progression patterns.

These two different CT patterns also correlate with a different survival rate.


Computed tomography Lung transplantation Organizing pneumonia Graft survival Pulmonary fibrosis 



Restrictive allograft syndrome


Chronic lung allograft dysfunction


Bronchiolitis obliterans syndrome


Neutrophilic reversible allograft dysfunction


Azithromycin reversible allograft dysfunction


Computed tomography


High-resolution CT


Forced expiratory volume in 1 second


Total lung capacity


Pulmonary function testing


Pleuroparenchymal fibroelastosis


Acute fibrinoid organizing pneumonia


Picture archiving and communication system



The scientific guarantor of this publication is Walter De Wever, MD PhD. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was not required for this study because of the retrospective nature.

Methodology: retrospective, diagnostic /observational study, performed at one institution.


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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  1. 1.Department of RadiologyUniversity Hospitals LeuvenLeuvenBelgium
  2. 2.Department of PneumologyUniversity Hospitals LeuvenLeuvenBelgium

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