Table 1 Summary of role of additional common tests in the workup of graft dysfunction
From: Imaging indications and findings in evaluation of lung transplant graft dysfunction and rejection
Workup | Uses |
|---|---|
Bronchoscopy | BAL: to exclude infection. Infection is considered in the differential of PGD, acute rejection (ACR, AMR), and BO/BOS. |
TBB: | |
 ACR: histopathological findings are the gold standard diagnostic test. | |
 AMR: histopathological findings and positive C4d stain are suggestive diagnostic features. | |
 BO: pathological findings are characteristic; disease is patchy and biopsy may be negative; not required for diagnosis. | |
 Recurrence of the primary lung disease such as sarcoidosis. | |
 Malignancy such as post-transplant lymphoproliferative disorder. | |
Airway: | |
 Dehiscence in early post-operative period. | |
 Stenosis and malacia can cause abnormal spirometry; differential diagnosis of BOS. | |
Spirometry | Sensitive in detecting graft dysfunction; |
BOS: irreversible obstructive pattern; > > 20% decline in FEV1 of baseline | |
RAS: irreversible restrictive pattern; > 20% decline in FEV1 of baseline. | |
Echocardiography | Cardiac dysfunction: cardiogenic edema or volume overload may cause diffuse lung opacities and should be considered in the differential of PGD in particular. |
CTA | Pulmonary embolism |
Pulmonary venous thrombosis: in the differential diagnosis of PGD. | |
GERD Workup | Aspiration: in the differential of PGD and acute rejection; may co-exist with either one; it is a potential risk factor of BO/BOS |