Chronic Lung Transplant Rejection


-Peak incidence: 16-20 months post-transplant (but may occur as early as 3 months and as late as years later)
-Incidence: 35-50% (early literature, prior to current immunosuppressives, cited incidence as high as 60%)
-Risk factors for chronic rejection:
1) Severe, recurrent, or persistent acute rejection (most strongly linked risk factor): see above
2) CMV infection (possible)
3) Bacterial pneumonia (possible)
4) Lymphocytic bronchiolitis (possible)
5) Organizing pneumonia (possible)

-Maintenance immunosuppression with tacrolimus vs CSA: demonstrated no difference in episodes of acute rejection but a decreased incidence of chronic rejection (Ann Thor Surg 1995; 60: 580)/ prolonged survival with tacrolimus (J Thor Cardiovasc Surg 1995; 109: 49)


CXR/Chest CT patterns: usually unchanged from baseline
HRCT: may reveal peripheral bronchiectasis/ patchy consolidation/ decreased peripheral vascular markings
-Expiratory air trapping is a sensitive and accurate predictor of brocnhiolitis obliterans in this patient population



Antithymocyte globulin/ antilymphocyte globulin/ OKT3:
Tacrolimus: inhibits IL-2 gene expression with suppression of T-cell activation and proliferation

Mycophenolate mofetil: inhibition of purine synthesis (similar to azathioprine)


Total lymphoid radiation:


Aerosolized CSA: