A Tale of Two Lungs: 99mTc-MAA Pulmonary Scintigraphy Reveals Unilateral Chronic Lung Allograft Dysfunction (CLAD) After Bilateral Living-Donor LobarLung Transplants (LDLLT)

A 14-year-old girl underwent bilateral living-donor lobar lung transplants (LDLLT) from each parent for bronchiolitis obliterans following hematopoietic stem cell transplantation (HSCT). Pulmonary perfusion scintigraphy demonstrated a marked reduction in blood flow in the father-derived graft, which subsequently collapsed and was diagnosed as chronic lung allograft dysfunction (CLAD), whereas the mother-derived graft remained stable and functional. The HSCT was performed with the mother's stem cells, theoretically preventing rejection of the mother's graft. This case highlights the unique immunologic dynamics arising from donor selection in HSCT and LDLLT, and underscores the usefulness of scintigraphy in the early detection of CLAD.