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
Complications | Time onset | Radiological findings | Diagnostic criteria/features |
|---|---|---|---|
Hyper-acute rejection | < 24 h | Diffuse pulmonary opacities. | It is a type of antibody-mediated rejection with no gold standard diagnostic test. |
Primary graft dysfunction | 0–72 h | Non-specific perihilar and basilar opacities and interstitial thickening. | Development of hypoxia and diffuse pulmonary radiographic opacities with no other identifiable cause. |
Acute cellular rejection | 1st week–1 year | Non-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 rejection | 1st week–1 year | No described specific imaging findings. | Presence of DSA, characteristic lung histology, and positive C4d within the graft. |
Bronchiolitis obliterans Syndrome | > 1 year | Air 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 year | Early: 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. |