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Table 3 Time onset, radiological findings, and diagnostic features of lung transplant primary graft dysfunction and different types of rejection

From: Imaging indications and findings in evaluation of lung transplant graft dysfunction and rejection

ComplicationsTime onsetRadiological findingsDiagnostic criteria/features
Hyper-acute rejection< 24 hDiffuse pulmonary opacities.It is a type of antibody-mediated rejection with no gold standard diagnostic test.
Primary graft dysfunction0–72 hNon-specific perihilar and basilar opacities and interstitial thickening.Development of hypoxia and diffuse pulmonary radiographic opacities with no other identifiable cause.
Acute cellular rejection1st week–1 yearNon-specific ground-glass opacities, consolidation, and interstitial thickening with or without pleural effusions.Diagnosed and graded based on pathologic findings on TBB specimens; lymphohistiocytic inflammatory infiltrates centered on small blood vessels; or bronchioles.
Acute antibody-mediated rejection1st week–1 yearNo described specific imaging findings.Presence of DSA, characteristic lung histology, and positive C4d within the graft.
Bronchiolitis obliterans
Syndrome
> 1 yearAir trapping on expiratory images; bronchial wall thickening; centrilobular nodules; with or without bronchiectasis.FEV1 decline ≥ 20% from baseline; irreversible obstructive PFT pattern. Pathology findings are characteristic but not required for diagnosis.
Restrictive allograft
syndrome
> 1 yearEarly: central and peripheral ground-glass opacities.
Late: peripheral and upper lung predominant reticulation, architecture distortion, and traction bronchiectasis with hilar retraction.
FEV1 decline ≥ 20% from baseline; total lung capacity decline ≥ 10% from baseline; irreversible restrictive PFT pattern.
  1. TBB, transbronchial biopsy; DSA, donor specific antigen; C4d, complement component 4d; FEV1, forced expiratory volume in 1 s; PFT, pulmonary function test