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Cerebral Tissue Pulmonary Embolism Masquerading as Primary Graft Dysfunction After Lung Transplantation
Shimon Izhakian1,2, Moshe Heching1,2, Ludmila Fridel2,3
1Pulmonary Institute Beilinson Hospital, Rabin Medical Center Petah Tikva Israel.
Pulmonary Circulation
|January 14, 2026
Summary
Cerebral tissue embolism, a rare cause of early graft dysfunction after lung transplantation, can mimic primary graft dysfunction (PGD). This case highlights the importance of considering donor-derived embolic events in PGD-like presentations.
Area of Science:
- Transplantation immunology
- Pulmonary medicine
- Pathology
Background:
- Early graft dysfunction is a significant complication following lung transplantation.
- Primary graft dysfunction (PGD) is the most common cause, but rare etiologies can present similarly.
Purpose of the Study:
- To report a unique case of cerebral tissue embolism presenting as early allograft dysfunction after lung transplantation.
- To raise awareness of this under-recognized cause of PGD-like symptoms.
Main Methods:
- Case report of a lung transplant recipient.
- Clinical and radiological assessment.
- Histopathological examination of transbronchial biopsies.
Main Results:
- The patient developed severe hypoxemia and diffuse pulmonary infiltrates post-transplant, consistent with Grade 3 PGD.
- Histopathology revealed cerebral cortical neurons and glial tissue in the pulmonary vasculature, confirming cerebral tissue embolism.
- The patient had received lungs from a donor with traumatic brain injury.
Conclusions:
- Cerebral tissue embolism is an under-recognized cause of early allograft dysfunction in lung transplantation.
- Clinicians should consider donor-derived embolic events, especially from trauma donors, in the differential diagnosis of PGD-like presentations.
