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Complications (Excluding Hyperinflation) Involving the Native Lung after Single-Lung Transplantation: Incidence, Radiologic Features, and Clinical Importance¹

¹ From the Departments of Radiology (H.P.M., J.J.E.) and Medicine, Division of Pulmonary and Critical Care Medicine (S.M.P.), Duke University Medical Center, Box 3808, Durham, NC 27710. Received February 22, 2000; revision requested April 7; revision received May 17; accepted June 1. Address correspondence to H.P.M. (e-mail: mcada003@mc.duke.edu).

PURPOSE: To determine the incidence, importance, and radiologic features of native lung complications after single-lung transplantation.

MATERIALS AND METHODS: Seventeen (15%) of 111 single-lung transplant recipients developed native lung complications (excluding hyperinflation) 0–58 months (mean, 17 months) after transplantation. Complaints at presentation, culture or histopathologic results, diagnostic or therapeutic procedures, and outcome were recorded. Chest radiographs (n = 17) and computed tomographic (CT) scans (n = 8) obtained at time of diagnosis were reviewed. Serial radiographs were assessed for disease progression or improvement.

RESULTS: The most common complications were infection (n = 10), caused by bacteria (n = 4), fungi (n = 4), or mycobacteria (n = 2), typically manifested as lobar or segmental opacities on chest radiographs or CT scans. Lung cancer manifested as a solitary well-circumscribed nodule (n = 1), multiple nodules (n = 1), or a hilar mass (n = 1). Five (29%) of 17 patients died of native lung complications. Seven patients underwent mediastinoscopy (n = 3), lobectomy (n = 2), thoracoscopic wedge resection (n = 2), tube thoracostomy (n = 2), or pneumonectomy (n = 1) for diagnosis or treatment.

CONCLUSION: Native lung complications occurred in 17 (15%) single-lung transplant recipients, were most commonly due to infection or lung cancer, and caused serious morbidity or mortality in 12 (71%) of 17 patients affected.

Index terms: Lung, abnormalities, 60.20, 60.2059, 60.21, 60.32, 60.458, 60.72, 60.731, 60.76 • Lung, transplantation, 60.458

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