Imaging in Lung Transplantation: Surgical Considerations of Donor and Recipient

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Key points

  • Imaging is an essential part of the evaluation process for potential lung transplant donors and recipients.

  • Extended lung donor criteria and emerging techniques in donor management have become more common as a means of increasing the donor pool.

  • Radiologists must be knowledgeable in identifying anatomic abnormalities and medical conditions with implications for surgical techniques in transplantation.

Donor evaluation

Despite the rise in number of lung transplants performed in the United States, availability of suitable donors is the main limitation for continued growth. The number of lungs transplanted per deceased donor has increased from 0.25 in 2000 to 0.39 in 2012, yet 75% of all lung offers are not accepted for transplantation.2, 3, 4, 5 Many potential donors are excluded from donation based on radiographic examinations. Twelve percent of potential lung donors are rejected for findings on chest

Recipient evaluation

Criteria for lung transplant vary based on the cause of underlying lung disease, yet there are common relative contraindications. Exclusion criteria often include age greater than 65 years, mechanical ventilation, extracorporeal membrane oxygenation, severely limited functional status, body mass index greater than 30, severe or symptomatic osteoporosis, or other systemic diseases with end-organ damage including cancer.25 Although the use of extended donor criteria has been demonstrated as a

Size matching

Matching a given donor to a recipient considers geography and blood type. Thoracic cavity size is also an important component. Acutely, oversized grafts experience compressive atelectasis with impaired ventilation. Chronically, size discrepancy is associated with reduced allograft and patient survival.59 In general, size differences of 15% to 30% are considered acceptable. There are several methods used for size matching. Most rely on characteristics including body morphometrics, underlying

Summary

Careful interpretation of imaging studies is critical for evaluating donor and recipient in lung transplantation. The radiologist must be facile in interpreting imaging findings to identify clinical conditions associated with poor outcomes or modifications in surgical technique. Communication between the radiologist and the medical and surgical teams can have significant impact on long-term outcomes.

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