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Kim SJ, Short RG, Beal MA, Byers DE, Javidan C, Raptis D. Imaging of Lung Transplantation. Clin Chest Med 2024; 45:445-460. [PMID: 38816099 DOI: 10.1016/j.ccm.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Lung transplantation is the only curative treatment for end-stage lung disease, which is caused by a wide variety of pathologies and encountered in a diverse range of patients. Potential recipients, as well as donors are carefully evaluated by imaging prior to transplant for contraindications to the transplant. After transplantation, recipients are imaged in the immediate, early, intermediate, and late periods for complications that may arise and require intervention. Radiography and computed tomography are the 2 most commonly used imaging modalities used to evaluate the chest after lung transplantation.
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Affiliation(s)
- Stacy J Kim
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University in St. Louis, Campus Box 8131, 510 S. Kingshighway Boulevard, St Louis, MO 63110, USA.
| | - Ryan G Short
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University in St. Louis, Campus Box 8131, 510 S. Kingshighway Boulevard, St Louis, MO 63110, USA
| | - Michael A Beal
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University in St. Louis, Campus Box 8131, 510 S. Kingshighway Boulevard, St Louis, MO 63110, USA
| | - Derek E Byers
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA
| | - Cylen Javidan
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University in St. Louis, Campus Box 8131, 510 S. Kingshighway Boulevard, St Louis, MO 63110, USA
| | - Demetrios Raptis
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University in St. Louis, Campus Box 8131, 510 S. Kingshighway Boulevard, St Louis, MO 63110, USA
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Kim SJ, Azour L, Hutchinson BD, Shirsat H, Zhou F, Narula N, Moreira AL, Angel L, Ko JP, Moore WH. Imaging Course of Lung Transplantation: From Patient Selection to Postoperative Complications. Radiographics 2021; 41:1043-1063. [PMID: 34197245 DOI: 10.1148/rg.2021200173] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Lung transplant is increasingly performed for the treatment of end-stage lung disease. As the number of lung transplants and transplant centers continues to rise, radiologists will more frequently participate in the care of patients undergoing lung transplant, both before and after transplant. Potential donors and recipients undergo chest radiography and CT as part of their pretransplant assessment to evaluate for contraindications to transplant and to aid in surgical planning. After transplant, recipients undergo imaging during the postoperative hospitalization and also in the long-term outpatient setting. Radiologists encounter a wide variety of conditions leading to end-stage lung disease and a myriad of posttransplant complications, some of which are unique to lung transplantation. Familiarity with these pathologic conditions, including their imaging findings and their temporal relationship to the transplant, is crucial to accurate radiologic interpretation. Knowledge of the surgical techniques and expected postoperative appearance prevents confusing normal posttransplant imaging findings with complications. A basic understanding of the indications, contraindications, and surgical considerations of lung transplant aids in imaging interpretation and protocoling and also facilitates communication between radiologists and transplant physicians. Despite medical and surgical advances over the past several decades, lung transplant recipients currently have an average posttransplant life expectancy of only 6.7 years. As members of the transplant team, radiologists can help maximize patient survival and hopefully increase posttransplant life expectancy and quality of life in the coming decades. ©RSNA, 2021 An invited commentary by Bierhals is available online. Online supplemental material is available for this article.
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Affiliation(s)
- Stacy J Kim
- From the Department of Radiology (S.J.K., L.A., J.P.K., W.H.M.), Department of Pathology (F.Z., N.N., A.L.M.), Department of Pulmonology, Critical Care, and Sleep Medicine (L.A.), and Transplant Institute (L.A.), New York University, New York, NY; Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (B.D.H.); and Department of Pathology, Vancouver Island Health Authority and University of British Columbia, Victoria, British Columbia, Canada (H.S.)
| | - Lea Azour
- From the Department of Radiology (S.J.K., L.A., J.P.K., W.H.M.), Department of Pathology (F.Z., N.N., A.L.M.), Department of Pulmonology, Critical Care, and Sleep Medicine (L.A.), and Transplant Institute (L.A.), New York University, New York, NY; Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (B.D.H.); and Department of Pathology, Vancouver Island Health Authority and University of British Columbia, Victoria, British Columbia, Canada (H.S.)
| | - Barry D Hutchinson
- From the Department of Radiology (S.J.K., L.A., J.P.K., W.H.M.), Department of Pathology (F.Z., N.N., A.L.M.), Department of Pulmonology, Critical Care, and Sleep Medicine (L.A.), and Transplant Institute (L.A.), New York University, New York, NY; Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (B.D.H.); and Department of Pathology, Vancouver Island Health Authority and University of British Columbia, Victoria, British Columbia, Canada (H.S.)
| | - Hemlata Shirsat
- From the Department of Radiology (S.J.K., L.A., J.P.K., W.H.M.), Department of Pathology (F.Z., N.N., A.L.M.), Department of Pulmonology, Critical Care, and Sleep Medicine (L.A.), and Transplant Institute (L.A.), New York University, New York, NY; Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (B.D.H.); and Department of Pathology, Vancouver Island Health Authority and University of British Columbia, Victoria, British Columbia, Canada (H.S.)
| | - Fang Zhou
- From the Department of Radiology (S.J.K., L.A., J.P.K., W.H.M.), Department of Pathology (F.Z., N.N., A.L.M.), Department of Pulmonology, Critical Care, and Sleep Medicine (L.A.), and Transplant Institute (L.A.), New York University, New York, NY; Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (B.D.H.); and Department of Pathology, Vancouver Island Health Authority and University of British Columbia, Victoria, British Columbia, Canada (H.S.)
| | - Navneet Narula
- From the Department of Radiology (S.J.K., L.A., J.P.K., W.H.M.), Department of Pathology (F.Z., N.N., A.L.M.), Department of Pulmonology, Critical Care, and Sleep Medicine (L.A.), and Transplant Institute (L.A.), New York University, New York, NY; Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (B.D.H.); and Department of Pathology, Vancouver Island Health Authority and University of British Columbia, Victoria, British Columbia, Canada (H.S.)
| | - Andre L Moreira
- From the Department of Radiology (S.J.K., L.A., J.P.K., W.H.M.), Department of Pathology (F.Z., N.N., A.L.M.), Department of Pulmonology, Critical Care, and Sleep Medicine (L.A.), and Transplant Institute (L.A.), New York University, New York, NY; Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (B.D.H.); and Department of Pathology, Vancouver Island Health Authority and University of British Columbia, Victoria, British Columbia, Canada (H.S.)
| | - Luis Angel
- From the Department of Radiology (S.J.K., L.A., J.P.K., W.H.M.), Department of Pathology (F.Z., N.N., A.L.M.), Department of Pulmonology, Critical Care, and Sleep Medicine (L.A.), and Transplant Institute (L.A.), New York University, New York, NY; Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (B.D.H.); and Department of Pathology, Vancouver Island Health Authority and University of British Columbia, Victoria, British Columbia, Canada (H.S.)
| | - Jane P Ko
- From the Department of Radiology (S.J.K., L.A., J.P.K., W.H.M.), Department of Pathology (F.Z., N.N., A.L.M.), Department of Pulmonology, Critical Care, and Sleep Medicine (L.A.), and Transplant Institute (L.A.), New York University, New York, NY; Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (B.D.H.); and Department of Pathology, Vancouver Island Health Authority and University of British Columbia, Victoria, British Columbia, Canada (H.S.)
| | - William H Moore
- From the Department of Radiology (S.J.K., L.A., J.P.K., W.H.M.), Department of Pathology (F.Z., N.N., A.L.M.), Department of Pulmonology, Critical Care, and Sleep Medicine (L.A.), and Transplant Institute (L.A.), New York University, New York, NY; Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (B.D.H.); and Department of Pathology, Vancouver Island Health Authority and University of British Columbia, Victoria, British Columbia, Canada (H.S.)
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Mojtabaee M, Shahryari S, Sadegh Beigee F. Reasons for Donor Lungs Unsuitability After Radiographic Selection. EXP CLIN TRANSPLANT 2019; 17:120-122. [PMID: 30777535 DOI: 10.6002/ect.mesot2018.o62] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Deceased lung donation requires optimum donor care, with lung viability greatly affected by the progress of the disease leading to brain death. In this study, we searched for causes of lung unsuitability for transplant in both primary and secondary evaluations. MATERIALS AND METHODS Primary lung evaluations included chest radiography, oxygen challenge test, and donor clinical and history examination. Secondary evaluations for lungs that passed the first step included fiberoptic bronchoscopy and donor-recipient matching. RESULTS From 2012 to 2017, there were 1020 potential deceased organ donors in our center. Primary evaluations showed that the most prominent reason for lung donation unsuitability was low oxygen challenge result (n = 433, 42.5%). Other reasons were abnormal chest radiograph (n = 378, 38%), history of heavy smoking and inhaled drugs addiction (n = 112, 11%), prolonged intubation (n = 28, 2.7%), and lung disease history (n = 69, 6.7%). There were 104 (10.1%) potential donors to undergo fiberoptic bronchoscopy for further lung evaluation, with 47 (45.2%) selected for final lung donation. Five lungs (4.8%) with bronchoscopic confirmation for suitability were not retrieved due to lack of instruments and resources. Among the 57 (54.8%) rejected potential lung donations, the greatest factor impacting suitability was observation of purulent secretions in bronchoscopy (n = 24, 23%), evidence of aspiration (n = 10, 9.6%), infiltration (n = 7, 6.7%), and tracheitis. CONCLUSIONS The most common cause of lung rejection after primary evaluation is observation of purulent secretions in tracheobronchial tree. Therefore, implementation of appropriate strategies to prevent respiratory infection in the intensive care unit is needed to expand the lung donor pool.
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Affiliation(s)
- Meysam Mojtabaee
- From the Organ Procurement Unit (OPU), Lung Transplantation Research Center (LTRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
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