The radiographic appearances of infection and acute rejection of the lung after heart-lung transplantation.

Thirty-two patients underwent combined heart and lung transplantation at Papworth Hospital between 1984 and 1987. The clinical and physiologic observations made at the time of episodes of infection and rejection together with the histopathology of lung tissue obtained by transbronchial lung biopsy were compared with pre- and postepisode chest radiographs. There were 45 episodes of rejection in 20 patients: 23 episodes during the first month after transplantation, and 22 after 1 month. Twenty-six episodes of infection occurred in 15 patients. The causative organisms included Aspergillus fumigatus, cytomegalovirus (CMV), herpes simplex, Pneumocystis carinii, and Staphylococcus aureus. When an abnormal chest radiograph is common during the first month after transplantation during acute rejection (74%), it may alternatively be due to lung infection (most commonly CMV pneumonitis). The chest radiograph during this period provides a useful indication for transbronchial biopsy and bronchial lavage. The chest radiograph is abnormal in the minority (23%) of episodes of rejection occurring later than 1 month after transplantation. Pulmonary function tests (FEV1 and VC) offered a more useful indication for transbronchial biopsy during this period.