Rejection In The Lung Transplant Recipient

The lung allograft is more susceptible to rejection than other solid organ al-lografts. Potential reasons for this include: the lung is one of the largest transplanted organs; its extensive vasculature is exposed to the entire cardiac output; unlike other allografts, it is routinely exposed to antigens from external environment via the airways; and the lung contains large populations of immunologically active cells (such as macrophages, dendritic cells, and lymphocytes). Furthermore, immunologic matching is crude (ABO blood type only) and immunosuppressive strategies remain imperfect.

Acute Rejection

Virtually all lung transplant recipients sustain an episode of acute rejection within the first month post-transplantation. Patients are susceptible to acute rejection anytime beginning 3 to 5 days post-transplantation to several years later, but the risk appears to decrease with time. Fortunately, most episodes of acute rejection rarely represent a serious problem. The clinical manifestations of acute rejection are nonspecific. In addition, the manifestations early after lung transplantation (within the first month) can differ substantially from those in the late phase (that is several months or even years after the transplant).50 In the early post-operative period, patients may experience a vague sensation of feeling unwell; they may also experience fever (more than 0.5°C above previous stable baseline), a drop in oxygenation (pO2 dropping by more than 10 mm Hg below

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