Clinically, rejection is suggested by tachypnea, fever and malaise. Suspicion is greater if patients are found to have: peripheral oxygen desaturation (pulse oximetry), pulmonary infiltrates noted on chest x-ray and decrement in pulmonary function studies, particularly the FEV 10. Bronchoscopy and transbronchial biopsy should be performed for diagnostic confirmation. Rarely, open lung biopsy may be required for diagnosis.

Pulse steroid therapy is the first line treatment for rejection. Rejection which is refractory to steroids should be treated with OKT3.

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