From the Guidelines
Lung transplant rejection can manifest through several key signs, including a decline in lung function tests, such as a persistent decline in FEV1 to ≤80% of baseline post-transplant FEV1, which is a surrogate marker of probable bronchiolitis obliterans syndrome (BOS) 1. The signs of lung transplant rejection can be categorized into early and late indicators. Early indicators include:
- Shortness of breath (dyspnea)
- Decreased exercise tolerance
- Persistent cough
- Declining lung function tests, such as FEV1 decline More serious signs include:
- Fever
- Increased sputum production (especially if discolored)
- Chest pain
- Oxygen saturation levels dropping below baseline
- Fatigue
- Unexplained weight loss
- Swelling in the legs or abdomen It is essential to note that acute rejection often presents with flu-like symptoms, while chronic rejection typically shows as a gradual decline in lung function over months 1. Infection signs include fever, increased sputum, and general malaise. Transplant recipients should immediately report any new or worsening symptoms to their transplant team, as early intervention significantly improves outcomes 1. Regular monitoring includes:
- Spirometry tests
- Chest X-rays
- Bronchoscopies
- Blood tests to detect rejection or infection before symptoms appear Patients should adhere strictly to their immunosuppressive medication regimen to prevent rejection, while maintaining vigilance for these warning signs throughout their post-transplant life.
From the Research
Signs of Lung Transplant Rejection
The signs of lung transplant rejection can be categorized into different types, including:
- Acute cellular rejection (ACR)
- Antibody-mediated rejection (AMR)
- Chronic lung allograft dysfunction (CLAD)
Acute Cellular Rejection
ACR is a common complication after lung transplantation 2. The diagnosis of ACR has well-defined histopathologic diagnostic criteria and grading 3, 4.
Antibody-Mediated Rejection
AMR requires a multidisciplinary diagnostic approach 3, 4.
Chronic Lung Allograft Dysfunction
CLAD is a major barrier to long-term survival following lung transplantation 3. The most common phenotype of CLAD is bronchiolitis obliterans syndrome (BOS), which is defined by a persistent obstructive decline in lung function 3, 5. Restrictive allograft dysfunction (RAS) is a second phenotype of CLAD and is associated with a worse prognosis 3.
Clinical Presentation and Treatment
The clinical presentation and treatment of acute rejection, AMR, and CLAD following lung transplantation have been reviewed 3, 2, 4. Tacrolimus therapy has been effective in the management of recalcitrant rejection in lung transplantation 6. The success of lung transplantation depends on careful management of immunosuppressive regimens to reduce the rate of rejection, while monitoring recipients for infections and complications to help identify problems early 5.