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Chronic rejection following lung transplantation. Incidence, time pattern and consequences
T Wahlers1, A Haverich, H J Schäfers
1Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Germany.
Summary
Chronic rejection impacts lung transplant (LTX) prognosis. Obstructive airway disease developed earlier after double lung transplants (DLTX) compared to heart-lung (HLTX) or single lung transplants (SLTX).
Area of Science:
- Pulmonary Medicine
- Transplantation Immunology
Background:
- Long-term lung transplant (LTX) prognosis is primarily limited by chronic rejection, manifesting as lung function decline and obliterative bronchiolitis (OB).
- The comparative incidence and temporal patterns of chronic rejection across different lung transplant types remain unclear.
Purpose of the Study:
- To investigate the differences in the incidence and time course of chronic rejection, specifically obstructive airway disease (OAD), following heart-lung (HLTX), double lung (DLTX), and single lung transplantation (SLTX).
Main Methods:
- Analysis of 64 lung transplant recipients transplanted before August 1992, excluding early and late deaths within 180 days.
- Obstructive airway disease was defined by a ≥25% drop in forced expiratory volume in one second (FEV1) relative to inspiratory vital capacity, assessed via serial lung function tests.
Main Results:
- The functional peak post-transplant was similar across all groups.
- Chronic lung function deterioration occurred earlier in DLTX recipients compared to HLTX and SLTX recipients.
- Obstructive airway disease was diagnosed in 45% of HLTX, 37% of DLTX, and 28% of SLTX patients, with significant morbidity including death and retransplantation.
Conclusions:
- Obstructive airway disease is a significant complication affecting all types of lung transplantation.
- There is a trend towards earlier OAD development after DLTX, potentially linked to a greater immunologic challenge in these recipients.