Lung transplant imaging: What radiologists need to know

Abstract Lung transplantation is a valuable treatment option for patients with end-stage lung disease, offering potential improvements in survival and quality of life. Radiologists play a vital role in both pre-transplant assessment and the postoperative management of lung transplant recipients by aiding in treatment planning and detection of complications and thereby ensuring optimal outcomes. Pre-transplant imaging is essential for assessing the extent and severity of lung disease, ascertaining the need for unilateral or bilateral transplantation, identifying potential contraindications, and facilitating surgical planning. Common indications for lung transplantation include obstructive lung disease (e.g., COPD, emphysema), fibrotic lung disease (e.g., idiopathic pulmonary fibrosis), infectious diseases (e.g., cystic fibrosis), and vascular lung diseases (e.g., pulmonary arterial hypertension). Post-transplant imaging is essential for the early detection of complications, commencing with routine chest radiographs in the immediate postoperative period followed by high-resolution CT for long-term surveillance. Common post-transplant complications include immunologic issues such as acute and chronic rejection, parenchymal complications like primary graft dysfunction, infections, airway and vascular complications, pleural complications, disease recurrence, and malignancies. Radiologists must be adept at recognizing these complications, as early intervention can markedly improve patient prognosis. This article provides a comprehensive overview of pre- and postoperative imaging in lung transplantation, emphasizing the importance of imaging in the early detection of complications. The worldwide increase in lung transplantation necessitates that radiologists become adept in recognizing imaging patterns associated with lung transplants and associated complications.