Role of imaging in lung transplantation evaluation

Lung transplantation is an effective treatment for patients with end-stage pulmonary disease. Due to the myriad of complications that can occur in the post-operative period and long-term after discharge, imaging plays a crucial role in the diagnosis and management of these patients. On imaging, the time of onset is most helpful in differentiating reimplantation response from acute rejection during the post-operative period. Bacterial and fungal infections may occur at any time after transplant, although viral infections tend to present after the post-operative period. Imaging is also helpful in evaluating post-operative pleural as well as short and long term airway anastomotic pathologies. Imaging is also useful in evaluating longer term pulmonary complications such as bronchiolitis obliterans, recurrent disease, and restrictive allograft syndrome. The imaging features of these various important thoracic complications of lung transplantation will be reviewed.