[Acute or chronic transplant rejection - high resolution CT of the chest in lung transplant recipients].
OBJECTIVE
Aim of the study was to evaluate the postoperative changes in patients with single (SLTX) or double lung transplantation (DLTX) with HRCT and to correlate those findings with the clinical diagnosis.


METHODS
29 patients with SLTX (n = 14) or DLTX (n = 15) were observed for more than 6 years after transplantation by HRCT (n = 82). CT examinations were performed in inspiration and expiration (n = 70) with a slice thickness of 1 mm and a feed of 10 mm. The image material was evaluated by 2 experienced radiologists in consensus. Criteria for acute rejection at HRCT were: ground glass opacities and focal air trapping in expiration. Criteria for chronic transplant rejection were: bronchial dilatation, bronchial wall thickening and thickening of interlobar septae. The clinical evaluation consisted of laboratory tests, lung function tests, and bronchoscopy including bronchial lavage in special cases.


RESULTS
20/29 patients are still alive (mean 21 months). 5/9 patients died because of chronic transplantant rejection, 1 patient suffered from a non-Hodgkin's lymphoma localised at the right hilus. Severe threatening pneumonia occurred in 13 cases. 10/29 patients showed symptoms of acute rejection. Expiratory HRCT found a focal air trapping in all cases and extended ground glass opacities in 11/14 cases. Also a bronchial dilatation was observed in more than 50 % (9/14). 12/29 patients suffered from chronic transplant rejection. HRCT showed bronchial dilatation in 26/27 investigations and severe ground glass opacities in 21/27 investigations. Thickening of the interlobal septa as well as centrilobular opacities were found in more than 50 % of the examinations.


CONCLUSIONS
High resolution CT of the chest in patients after lung transplantation is able to show numerous pathological alterations. Without clinical information a confident differentiation in acute or chronic transplant rejection or pneumonia can be difficult or impossible.
Herber
S
S
Klinik und Poliklinik für Radiologie, Johannes-Gutenberg-Universität Mainz. herber@radiologie.klinik.uni-mainz.de
Lill
J
J
Heussel
C P
CP
Mayer
E
E
Thelen
M
M
Kauczor
H U
HU
D000208:Acute Disease; D000328:Adult; D001989:Bronchiolitis Obliterans / Q000000981:diagnostic imaging / Q000401:mortality; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000000981:diagnostic imaging* / Q000401:mortality; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement; D015996:Survival Rate; D014057:Tomography, X-Ray Computed