Noninfectious pulmonary complications after organ transplantation

Organ transplantation is a successful and recognized option for patients with end-stage pulmonary, cardiac, hepatic, renal, and hematologic disease. As with any new technology, however, a set of complications has developed in the form of lung injury after transplantation as a result of ischemic, chemotherapeutic, radiation-induced, and immunologic damage to the lungs. Interstitial changes soon after transplantation are typically due to pulmonary edema, the adult respiratory distress syndrome, and reperfusion injury or allograft rejection (in the case of lung transplantation). Late pulmonary injury presents as obliterative bronchiolitis and lymphoproliferative disease. Bone marrow transplant recipients are unique because they develop the idiopathic pneumonia syndrome, diffuse alveolar hemorrhage, pulmonary venoocclusive disease, and graft-versus-host disease. New insights about these interstitial syndromes are the subject of this review.