The first human lung transplantation was performed in 1963 but was unsuccessful. When cyclosporine was introduced in the early 1980s, the era of solid organ transplantation began. The first long-term success with human single lung transplantation, which was modeled on the concepts established for heart–lung transplantation at Stanford University, occurred in 1983 at the Toronto General Hospital. In 1986, the technique for double lung transplantation was successfully developed. The field of lung transplantation has evolved dramatically in the past 16 years. <sup>2American Thoracic Society Lung transplantation Am Rev Respir Dis 1993 ;  147 : 772-776

Cliccare qui per andare alla sezione Riferimenti, 15Collins J., Kuhlman J.E., Love R.B. Acute, life-threatening complications of lung transplantation RadioGraphics 1998 ;  18 : 21-43

Cliccare qui per andare alla sezione Riferimenti, 21Davis R.J., Pasque M.K. Pulmonary transplantation Ann Surg 1995 ;  221 : 14-28 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 26Garg K., Zamora M., Tuder R., e al. Lung transplantation: Indications, donor and recipient selection and imaging of complications RadioGraphics 1996 ;  16 : 355-367

Cliccare qui per andare alla sezione Riferimenti, 32Herman S.J. Radiologic assessment after lung transplantation Clin Chest Med 1990 ;  11 : 333-346

Cliccare qui per andare alla sezione Riferimenti, 37Judson M.A. Clinical aspects of lung transplantation Clin Chest Med 1993 ;  14 : 335-357

Cliccare qui per andare alla sezione Riferimenti, 50Montefusco C.M., Veith F.J. Lung transplantation Surg Clin North Am 1986 ;  66 : 503-515

Cliccare qui per andare alla sezione Riferimenti, 52Murray J.G., McAdams H.P., Erasmus J.J., e al. Complications of lung transplantation: Radiologic findings AJR Am J Roentgenol 1996 ;  166 : 1405-1411

Cliccare qui per andare alla sezione Riferimenti, 53O'Donovan P.B. Imaging of complications of lung transplantation RadioGraphics 1993 ;  13 : 787-796

Cliccare qui per andare alla sezione Riferimenti, 70Theodore J., Lewiston N. Lung transplantation comes of age N Engl J Med 1990 ;  322 : 772-774 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 72Trulock E.P. Lung transplantation Am J Respir Crit Care Med 1997 ;  155 : 789-818

Cliccare qui per andare alla sezione Riferimenti</sup> One-year survival after lung transplantation is now 80% to 90% and 5-year survival is approximately 50%.<sup>21Davis R.J., Pasque M.K. Pulmonary transplantation Ann Surg 1995 ;  221 : 14-28 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> The operative mortality rate is less than 10%. Lung transplantation is now an accepted treatment for a large number of end-stage pulmonary diseases, including, but not limited to, emphysema, cystic fibrosis, pulmonary fibrosis, sarcoidosis, lymphangioleiomyomatosis, and primary pulmonary hypertension.

Several factors have led to the ultimate success of lung transplantation, including (1) improved recipient assessment and selection, (2) improved intensive care unit care, (3) better understanding of the mechanism of rejection and refinements in immunosuppressive regimens, (4) improved prevention, diagnosis, and treatment of infections, (5) improved surgical techniques to overcome problems of airway ischemia, and (6) development of effective rehabilitation programs.

Major challenges remain, however. <sup>18Daly R.C. Lung transplantation: Where are we today? Mayo Clin Proc 1997 ;  72 : 77-78 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 19Daly R.C., McGregor C.G.A. Surgical issues in lung transplantation: Options, donor selection graft preservation, and airway healing Mayo Clin Proc 1997 ;  72 : 79-84

Cliccare qui per andare alla sezione Riferimenti</sup> The major obstacle to the growth of lung transplant programs is the limited supply of suitable donors. Only 20% to 30% of multi-organ donors have lungs that are suitable for transplantation because of the high incidence of complications such as aspiration pneumonia, atelectasis, and the pulmonary edema associated with donor brain death. More recently, the harvest of lower lobes from two living donors for double lung transplant has been performed successfully by several groups, thereby shortening the wait for a suitable donor.<sup>67Starnes V.A., Barr M.L., Cohen R.G. Lobar transplantation: Indications, technique and outcome J Thorac Cardiovasc Surg 1994 ;  108 : 403-410

Cliccare qui per andare alla sezione Riferimenti</sup> The development of obliterative bronchiolitis in up to 50% of long-term survivors remains another major challenge. Obliterative bronchiolitis is the major factor affecting long-term survival and quality of life. <sup>32Herman S.J. Radiologic assessment after lung transplantation Clin Chest Med 1990 ;  11 : 333-346

Cliccare qui per andare alla sezione Riferimenti, 35International Society of Heart and Lung Transplantation, Cooper J.D., Billingham M., e al. A working formulation for the standardization of nomenclature and for clinical staging of chronic dysfunction in lung allografts J Heart Lung Transplant 1993 ;  12 : 713-716

Cliccare qui per andare alla sezione Riferimenti</sup>

Several complications pertain specifically to lung transplant recipients, including airway ischemia, reperfusion edema, infections, acute rejection, obliterative bronchiolitis and other postoperative problems related to surgical technique and immunosuppressive therapy. Imaging procedures play an important role in the diagnosis and management of these problems. This article focuses on the imaging appearance of these complications.^{*References 2,15,21,26,32,37,50,52,53,70 and 72.}