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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

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.
  1. TBB, transbronchial biopsy; DSA, donor specific antigen; C4d, complement component 4d; FEV1, forced expiratory volume in 1 s; PFT, pulmonary function test