Medical Archive

Indications

Referral and recipient selection

Waiting list and organ allocation

Transplant procedure

Posttransplantation management

Immunosuppression

Spirometry and bronchoscopy

Outcomes

Survival

Function

Quality of life

Cost

Complications

Primary graft dysfunction

Airway complications

Lung allograft dysfunction

Acute cellular rejection

• Cell-mediated response
• Clinical presentation
  • ?6 months after transplant
  • Asymptomatic or fever, cough, dyspnea
• Diagnosis
  • BAL to r/o infection
  • Biopsy: submucosal lymphocytic infiltrate, perivascular inflammation
• Management
  • High-dose glucocorticoids

Chronic lung allograft dysfunction

• Mixed cell-mediated & antibody response
  • Submucosal lymphocytic inflammation in the walls of the small airways
  • Ingrowth of granulation tissue into the lumen 
  • Airway obstruction and obliteration (bronchiolitis obliterans)
• Clinical presentation
  • Months to years after transplant (~50% in 5Y post-LT)
  • Progressive cough & dyspnea
• Diagnosis
  • PFT: obstructive pattern
  • BAL to r/o infection
  • Biopsy: submucosal lymphocytic infiltrate, bronchiolitis obliterans
• Management
  • Supportive management
  • Possible repeat transplant

Humoral rejection

Infection

• CMV viremia/pneumonia is m/c.
  • Mostly in the first 6 months.
  • Most problematic fungus: aspergillus spp.
  • Other community-acquired viruses: influenza, parainfluenza, RSV

Other complications