Reperfusion edema after lung transplantation: Radiographic manifestations

PURPOSE: To characterize the radiographic manifestations of reperfusion edema after lung transplantation and to correlate the severity of the radiographic findings with pulmonary physiology. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSION: Reperfusion edema is almost invariable after lung transplantation and most often appears as air-space disease in the middle and /lower lung zones. The severity of radiographic findings is a poor indicator of pulmonary physiology.