THORACIC Section 10: Transplant

Question 1

Secondary to HLA and ABO antigens. It’s rapid and often fatal. Imaging shows massive homogenous infiltration

Answer 1

Hyperacute rejection

Question 2

Immediate complications post-transplant (<24 hours)

Answer 2

Donor-Recipient Size Mismatch

Hyperacute Rejection

Question 3

Peaks at day 4 as a non-cardiogenic edema related to ischemia- reperfusion. Typically improves by day 7.

Answer 3

Reperfusion Injury

Question 4

Defined as a continuous leak for more than 7 days.

Answer 4

Air Leak / Persistent Pneumotliorax

Question 5

Early Complications (24 hours - 1 week)

Answer 5

Reperfusion Injury
Air Leak / Persistent Pneumotliorax

Question 6

Ground glass opacities and intralobular septal thickening. (No ground glass = no rejection). Improves with steroids.

Answer 6

Acute Rejection

Question 7

Leaks occur in the first month, stenosis can develop later (2-4 months).

Answer 7

Bronchial Anastomotic Complications

Question 8

Intermediate Complication (8 days - 2 months)

Answer 8

Acute Rejection
Bronchial Anastomotic Complications

Question 9

The most common opportunistic infection.

Answer 9

CMV Infection

Question 10

What happens in chronic rejection

Answer 10

Bronchiolitis Obliterans; Affects 50% at 5 years. Brochiectasis, bronchial wall thickening, air trapping.

Question 11

Occurs with chronic rejection (but more commonly with acute rejection). Responds to steroids.

Answer 11

Cryptogenic Organizing Pneumonia

Question 12

Typically seen within the first year. EBV in 90%.

Answer 12

PTLD

Question 13

Associated with chronic rejection

Answer 13

Upper Lobe Fibrosis

Question 14

This is the major late complication, that affects at least half of the transplants at 5 years (most commonly at 6 months).

Answer 14

Chronic Rejection /Bronchiolitis Obliterans Syndrome

Question 15

most common recurrent primary disease (around 35%).

Answer 15

Sarcoidosis