Imaging of Lung Transplantation

  • Jitesh AhujaEmail author
  • Siddhartha G. Kapnadak
  • Sudhakar Pipavath


Lung transplantation has become a viable treatment option for end-stage lung disease. Common indications for lung transplantation are chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis, cystic fibrosis, alpha-1 antitrypsin deficiency, and pulmonary arterial hypertension. Either single or bilateral lung transplantation can be performed, but bilateral lung recipients appear to have a better median survival than single lung recipients. Complications after lung transplantation are common and may have nonspecific clinical and radiologic manifestations. The time point at which these complications occur relative to the date of transplant is crucial in formulating a differential diagnosis and recognizing them accurately. Significant advances in imaging techniques and recognition of air trapping in exhalation images and other patterns /distribution of parenchymal abnormalities have led to routine use of HRCT for diagnostic evaluation in patients manifesting respiratory decline in the lung transplant recipient.


Lung Transplantation Complication Infection Imaging Rejection 


  1. 1.
    Yusen RD, Edwards LB, Kucheryavaya AY, Benden C, Dipchand AI, Dobbels F, et al. The registry of the International Society for Heart and Lung Transplantation: thirty-first adult lung and heart-lung transplant report--2014; focus theme: retransplantation. J Heart Lung Transplant. 2014;33(10):1009–24.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Frost AE. Donor criteria and evaluation. Clin Chest Med. 1997;18(2):231–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Kuno R, Kanter KR, Torres WE, Lawrence EC. Single lung transplantation followed by contralateral bullectomy for bullous emphysema. J Heart Lung Transplant. 1996;15(4):389–94.PubMedGoogle Scholar
  4. 4.
    Frost AE, Jammal CT, Cagle PT. Hyperacute rejection following lung transplantation. Chest. 1996;110(2):559–62.CrossRefPubMedGoogle Scholar
  5. 5.
    Kundu S, Herman SJ, Winton TL. Reperfusion edema after lung transplantation: radiographic manifestations. Radiology. 1998;206(1):75–80.CrossRefPubMedGoogle Scholar
  6. 6.
    Herridge MS, de Hoyos AL, Chaparro C, Winton TL, Kesten S, Maurer JR. Pleural complications in lung transplant recipients. J Thorac Cardiovasc Surg. 1995;110(1):22–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Ferrer J, Roldan J, Roman A, Bravo C, Monforte V, Pallissa E, et al. Acute and chronic pleural complications in lung transplantation. J Heart Lung Transplant. 2003;22(11):1217–25.CrossRefPubMedGoogle Scholar
  8. 8.
    Arndt A, Boffa DJ. Pleural space complications associated with lung transplantation. Thorac Surg Clin. 2015;25(1):87–95.CrossRefPubMedGoogle Scholar
  9. 9.
    King-Biggs MB. Acute pulmonary allograft rejection. Mechanisms, diagnosis, and management. Clin Chest Med. 1997;18(2):301–10.CrossRefPubMedGoogle Scholar
  10. 10.
    Christie JD, Edwards LB, Aurora P, Dobbels F, Kirk R, Rahmel AO, et al. The Registry of the International Society for Heart and Lung Transplantation: twenty-sixth official adult lung and heart-lung transplantation report-2009. J Heart Lung Transplant. 2009;28(10):1031–49.CrossRefPubMedGoogle Scholar
  11. 11.
    Knoop C, Estenne M. Acute and chronic rejection after lung transplantation. Semin Respir Crit Care Med. 2006;27(5):521–33.CrossRefPubMedGoogle Scholar
  12. 12.
    Alvarez A, Algar J, Santos F, Lama R, Aranda JL, Baamonde C, et al. Airway complications after lung transplantation: a review of 151 anastomoses. Eur J Cardiothorac Surg. 2001;19(4):381–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Ng YL, Paul N, Patsios D, Walsham A, Chung TB, Keshavjee S, et al. Imaging of lung transplantation: review. AJR Am J Roentgenol. 2009;192(3 Suppl):S1–13, quiz S4–9.PubMedGoogle Scholar
  14. 14.
    Clark SC, Levine AJ, Hasan A, Hilton CJ, Forty J, Dark JH. Vascular complications of lung transplantation. Ann Thorac Surg. 1996;61(4):1079–82.CrossRefPubMedGoogle Scholar
  15. 15.
    Krishnam MS, Suh RD, Tomasian A, Goldin JG, Lai C, Brown K, et al. Postoperative complications of lung transplantation: radiologic findings along a time continuum. Radiographics. 2007;27(4):957–74.CrossRefPubMedGoogle Scholar
  16. 16.
    Avery RK. Infections after lung transplantation. Semin Respir Crit Care Med. 2006;27(5):544–51.CrossRefPubMedGoogle Scholar
  17. 17.
    Collins J, Muller NL, Kazerooni EA, Paciocco G. CT findings of pneumonia after lung transplantation. AJR Am J Roentgenol. 2000;175(3):811–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Paraskeva M, Bailey M, Levvey BJ, Griffiths AP, Kotsimbos TC, Williams TP, et al. Cytomegalovirus replication within the lung allograft is associated with bronchiolitis obliterans syndrome. Am J Transplant. 2011;11(10):2190–6.CrossRefPubMedGoogle Scholar
  19. 19.
    Collins J. Imaging of the chest after lung transplantation. J Thorac Imaging. 2002;17(2):102–12.CrossRefPubMedGoogle Scholar
  20. 20.
    Estenne M, Maurer JR, Boehler A, Egan JJ, Frost A, Hertz M, et al. Bronchiolitis obliterans syndrome 2001: an update of the diagnostic criteria. J Heart Lung Transplant. 2002;21(3):297–310.CrossRefPubMedGoogle Scholar
  21. 21.
    Verleden GM, Raghu G, Meyer KC, Glanville AR, Corris P. A new classification system for chronic lung allograft dysfunction. J Heart Lung Transplant. 2014;33(2):127–33.CrossRefPubMedGoogle Scholar
  22. 22.
    Lee ES, Gotway MB, Reddy GP, Golden JA, Keith FM, Webb WR. Early bronchiolitis obliterans following lung transplantation: accuracy of expiratory thin-section CT for diagnosis. Radiology. 2000;216(2):472–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Chaparro C, Chamberlain D, Maurer J, Winton T, Dehoyos A, Kesten S. Bronchiolitis obliterans organizing pneumonia (BOOP) in lung transplant recipients. Chest. 1996;110(5):1150–4.CrossRefPubMedGoogle Scholar
  24. 24.
    Arakawa H, Kurihara Y, Niimi H, Nakajima Y, Johkoh T, Nakamura H. Bronchiolitis obliterans with organizing pneumonia versus chronic eosinophilic pneumonia: high-resolution CT findings in 81 patients. AJR Am J Roentgenol. 2001;176(4):1053–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Reams BD, McAdams HP, Howell DN, Steele MP, Davis RD, Palmer SM. Posttransplant lymphoproliferative disorder: incidence, presentation, and response to treatment in lung transplant recipients. Chest. 2003;124(4):1242–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Paranjothi S, Yusen RD, Kraus MD, Lynch JP, Patterson GA, Trulock EP. Lymphoproliferative disease after lung transplantation: comparison of presentation and outcome of early and late cases. J Heart Lung Transplant. 2001;20(10):1054–63.CrossRefPubMedGoogle Scholar
  27. 27.
    Carignan S, Staples CA, Muller NL. Intrathoracic lymphoproliferative disorders in the immunocompromised patient: CT findings. Radiology. 1995;197(1):53–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Dodd GD III, Ledesma-Medina J, Baron RL, Fuhrman CR. Post-transplant lymphoproliferative disorder: intrathoracic manifestations. Radiology. 1992;184(1):65–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Scarsbrook AF, Warakaulle DR, Dattani M, Traill Z. Post-transplantation lymphoproliferative disorder: the spectrum of imaging appearances. Clin Radiol. 2005;60(1):47–55.CrossRefPubMedGoogle Scholar
  30. 30.
    Rappaport DC, Chamberlain DW, Shepherd FA, Hutcheon MA. Lymphoproliferative disorders after lung transplantation: imaging features. Radiology. 1998;206(2):519–24.CrossRefPubMedGoogle Scholar
  31. 31.
    Konen E, Weisbrod GL, Pakhale S, Chung T, Paul NS, Hutcheon MA. Fibrosis of the upper lobes: a newly identified late-onset complication after lung transplantation? AJR Am J Roentgenol. 2003;181(6):1539–43.CrossRefPubMedGoogle Scholar
  32. 32.
    Collins J, Hartman MJ, Warner TF, Muller NL, Kazerooni EA, McAdams HP, et al. Frequency and CT findings of recurrent disease after lung transplantation. Radiology. 2001;219(2):503–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Kazerooni EA, Jackson C, Cascade PN. Sarcoidosis: recurrence of primary disease in transplanted lungs. Radiology. 1994;192(2):461–4.CrossRefPubMedGoogle Scholar
  34. 34.
    Boehler A, Vogt P, Zollinger A, Weder W, Speich R. Prospective study of the value of transbronchial lung biopsy after lung transplantation. Eur Respir J. 1996;9(4):658–62.CrossRefPubMedGoogle Scholar
  35. 35.
    Kazerooni EA, Cascade PN, Gross BH. Transplanted lungs: nodules following transbronchial biopsy. Radiology. 1995;194(1):209–12.CrossRefPubMedGoogle Scholar

Copyright information

© The Author(s) 2018

Authors and Affiliations

  • Jitesh Ahuja
    • 1
    Email author
  • Siddhartha G. Kapnadak
    • 2
  • Sudhakar Pipavath
    • 1
  1. 1.Department of RadiologyUniversity of Washington Medical CenterSeattleUSA
  2. 2.Division of Pulmonary and Critical Care MedicineUniversity of Washington Medical CenterSeattleUSA

Personalised recommendations