Learning objectives
1. Discuss radiologic appearances of the surgical techniques post lung transplantation.
2. Recognise the radiologic findings of common early and late complications of lung transplantation.
Background
Lung transplantation is an established treatment for end-stage pulmonary disease: COPD, interstitial lung disease, cystic fibrosis, pulmonary arterial hypertension, end-stage sarcoidosis, cystic lung disease.
The International Society for Heart and Lung Transplantation Registry indicated that 70,000 lung transplants have been performed worldwide (as of July 2020), with many lung transplant recipients still alive.
Estimated 5-year/10-year post-transplant survival is 59% and 27% respectively.
The combination of different surgical techniques, variety of acute and chronic complications manifest different patterns for radiologists for imaging interpretation.
Imaging findings OR Procedure details
Surgical Techniques
Early surgical techniques utilised an end-to-end anastomosis, wrapped with intercostal muscle or omentum to improve healing. Omental wrap predisposed to complications such as diaphragmatic hernias.
Current surgical techniques use a 'telescopic' technique which involves bronchial overlap (smaller bronchus is telescoped into the larger bronchus). Performed without omental wrap with good success.
Lobar implantation may occur when the donor lung is large for the recipient body - only parts of the donor lung are implanted (e.g. pulmonary fibrosis recipients).
Airway Complications
The donor bronchus...
Conclusion
Radiology is important for the diagnosis and management of lung transplantation complications. Although radiologic patterns may be non-specific, the time course from lung transplantation and relevant postoperative history generate a clinically useful and relevant radiologic opinion. Familiarity with the pre-transplantation disease is useful in assessing the possibility of disease recurrence.
References
1. Ng YL, Paul N, Patsios D, Walsham A, Chung TB, Keshavjee S, Weisbrod G. Imaging of Lung Transplantation: review. AJR Am J Roentgenol. 2009 Mar;192(3 Suppl):S1-13, quiz S14-9. doi: 10.2214/AJR.07.7061
2. D.Byrne et al. Chronic Lung Allograft Dysfunction: Review of CT and Pathologic Findings. Radiology: Cardiothoracic Imaging 2021;3(1):e200314
3. Collins J, Kuhlman JE and Love RB. Acute, life-threatening complications of lung transplantation. Radiographics 1998; 18:21-43.
4. Anderson DC, Glazer HS, Semenkovich JW et al. Lung transplant edema: Chest radiography after lung transplantation – The...