Heart-lung transplantation: the postoperative chest radiograph

The postoperative chest radiographs of 10 patients who had undergone heart-lung transplantation at Stanford University Medical Center were evaluated and compared with those of 10 consecutive cardiac transplantation patients and 10 consecutive coronary artery bypass graft patients. In the second week after surgery, we observed an interstitial radiographic pattern in the heart-lung transplantation patients but not in the other two patient populations. This pattern, which did not correspond with any clinical evidence of infection, rejection, fluid overload, or oxygen toxicity, may represent the reimplantation response described in dogs and primates following transplantation of a single lung. This response may be related to the interruption of bronchial circulation, the denervation of both lungs, and the lymphatic interruption that occur during transplantation. It may also be related to the obligatory period of ischemia that is incurred during implantation.