Acute rejection after lung transplantation: association between histopathological and CT findings

Graft dysfunction and rejection of lung transplant, a review on diagnosis and management

“…The International Society for Heart and Lung Transplantation (ISHLT) has established diagnostic and grading criteria for acute allograft rejection based on the degree of lymphocytic infiltration from grade A0 to grade A4 diffuse infiltration (Table 3 ). 19 , 20 , 21 Imaging manifestations are of poor sensitivity and specificity in acute allograft rejection, with the main signs including multifocal ground‐glass opacities, interlobular septal thickening, and consolidations, accompanied by pleural effusions or not. 22 However, CT plays an important role in ruling out causes apart from acute allograft rejection and aiding in the localization of transbronchial biopsy.…”

Surveillance for acute cellular rejection after lung transplantation

“…Certain features on CT, such as ground-glass opacities, inter-lobar septal thickening, particularly when involvement is bilateral and predominantly basal, have a reported accuracy of almost 90% within the small sample cohort. A recent, somewhat larger retrospective analysis of 78 patients has again cast some doubt on the utility, but failure to distinguish between symptomatic and asymptomatic patients in the latter may have influenced their findings (54). Undoubtedly, sensitivity remains an important weakness and in themselves the features mentioned, as well as pleural or pericardial effusions in the absence of further evidence of cardiac decompensation, should increase suspicion, but are in themselves not diagnostic and demand further investigation (55).…”