Acute Rejection, Lung
GENERAL PRINCIPLES
• Of the solid organ transplants, the lung is one of the most immunogenic organs.
• The majority of patients have at least one episode of acute rejection.
Multiple episodes of acute rejection predispose to the development of chronic rejection (bronchiolitis obliterans syndrome).• Lung transplant rejection occurs most commonly in the first few months after transplantation.
DIAGNOSIS
Diagnosis is generally made by fiberoptic bronchoscopy with bronchoalveolar lavage and transbronchial biopsies.
Clinical Presentation
Manifestations are nonspecific and include fever, dyspnea, and a nonproductive cough. The chest radiograph is typically unchanged and is generally nondiagnostic even when abnormal (perihilar infiltrates, interstitial edema, pleural effusions). Change in pulmonary function testing is not specific for rejection, but a 10% or greater decline in FVC and/or FEV1 is clinically significant.
Differential Diagnosis
It is important to distinguish rejection from infection because although the symptoms are similar, the treatments are markedly different.