Reperfusion edema after lung transplantation: radiographic manifestations

To characterize the radiographic manifestations of reperfusion edema after lung transplantation and to correlate the severity of the radiographic findings with pulmonary physiology.

Chest radiographs obtained after 45 lung transplantation procedures (20 single, 25 double) were reviewed retrospectively. Physiologic parameters (alveolar-arterial gradient, ratio of partial pressure of oxygen to fraction of inspired oxygen) were noted in patients who underwent intubation.

Reperfusion edema appeared on day 1 in 39 transplants and by day 3 in 44. One patient's lungs remained clear. Peak severity occurred by day 4 in 43 of 44 transplants. At peak severity, reperfusion edema appeared as reticular interstitial disease in the upper (19%), middle (33%), and lower (34%) lung zones or air-space disease in the upper (31%), middle (61%), and lower (57%) zones. Reperfusion edema was asymmetric after double-lung transplantation in nine patients. The process cleared by day 10 in five transplants and by day 21 in another seven. There was a poor correlation between the severity of radiographic findings and physiologic measurements.

Reperfusion edema is almost invariable after lung transplantation and most often appears as air-space disease in the middle and/or lower lung zones. The severity of radiographic findings is a poor indicator of pulmonary physiology.