LUNG TRANSPLANTATION INDICATIONS, DONOR AND RECIPIENT SELECTION, AND IMAGING OF COMPLICATIONS

Lung transplantation has become a well-established treatment for endst age pulmonary parenchymal and vascular disease. Careful selection of r ecipients and donors is important to decrease early graft failure, whi ch is primarily due to rejection and bronchial dehiscence. Common comp lications include the reimplantation response, acute rejection, pleura l effusion, lymphoproliferative disorders, bronchiolitis obliterans, i nfection, and airway stenosis or dehiscence. The reimplantation respon se is a form of noncardiogenic pulmonary edema that begins soon after surgery and resolves in days to weeks. Acute rejection occurs in most recipients; a dramatic response to steroid therapy is the most diagnos tic clinical feature. Lymphoproliferative disorders are posttransplant ation neoplasms that may disappear when immunosuppressive therapy is s topped and often manifest as a discrete lung mass. In bronchiolitis ob literans-a major long-term complication probably due to chronic reject ion-computed tomography (CT) often shows bronchial dilatation and air trapping. Airway stenosis and dehiscence are easily diagnosed with bro nchoscopy and CT. Infections remain the major cause of morbidity and m ortality.