The Temporal Continuum of Lung Transplant Imaging: Mapping Preoperative Assessment and Post-Surgical Complications

Lung transplantation is the definitive treatment in the management of end-stage lung diseases. With various advancements in the transplantation process, an increase in the number of transplants performed, recovery rates, and survival rates has been observed. Indications for performing lung transplantation include obstructive lung disease, fibrotic lung disease, chronic infectious lung conditions, and advanced pulmonary vascular diseases. Radiologists play a crucial role in the transplantation process in terms of donor assessment, which initially includes a chest X-ray, followed by high-resolution computed tomography (HRCT) of the chest to determine eligibility for transplantation. Pretransplant recipient assessment, on the other hand, aims at evaluating the status and severity of the disease, size matching, and the identification of any contraindications. Radiological assessment is equally crucial in the postoperative period. In the immediate postoperative phase, imaging includes chest X-rays and HRCT for the detection of complications like pleural effusions, pulmonary edema, pneumothorax, vascular complications, and primary graft dysfunction/acute rejection. Long-term radiological follow-up involves the detection of complications such as acute and chronic graft rejection, infections, pleural disease, airway complications, vascular complications, and malignancies. Early recognition of these conditions is of utmost importance, as it significantly affects the morbidity and mortality of the patients. This article provides a comprehensive overview of the role of imaging in the pre- and post-lung transplantation periods, and highlights the spectrum of postoperative complications and their implications for transplant outcomes and management.