The problems of transplanted organs are legion, and lung transplantation is probably one of the most difficult transplants to maintain. Aerosol applications may play a role. Major problems include transplant rejection, pulmonary hypertension, infection, and progressive bronchial obstruction caused by an immune response in the airways.
During lung transplantation, pulmonary vascular pressure and an intrapulmonary shunt have been shown to respond to inhaled nitric oxide and inhaled aerosolized prostacyclin [149,150]. Aerosolized prostacyclin has also been described as an alternative to nitric oxide in the management of reperfusion injury after lung transplantation .
Acute and chronic rejection are major problems compromising transplant and patient survival. Many studies indicate that aerosolized cyclosporin A is useful for reducing the risk of acute rejection. The lung concentrates and retains cyclosporin A better after inhalation [152,153]. A number in investigators have found that aerosolized cyclosporin reduces acute rejection in animals [154-157], and some studies suggest efficacy in treating acute  and chronic [159,160] rejection in human transplant recipients.
Immunosuppression associated with transplantation makes recipients susceptible to opportunistic infections. Inhaled antimicrobial agents, including pentamidine for Pneumocystis carinii prevention , colistin for Pseudomonas in CF patients awaiting transplant , and amphotericin B lipid complex prophylaxis against postransplant fungal infection  have all been described. These various studies suggest much potential for aerosolized medications to protect transplanted lungs.
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