Our Summary

This research paper reviews acute cellular rejection (ACR), a common issue after a lung transplant. While ACR-related deaths are rare and most patients react well to initial treatment, some people may experience persistent or recurring ACR. This can lead to rapid deterioration of lung function and eventually, chronic lung allograft dysfunction. Further, the risk of infection increases with the intensification of immunosuppression therapy, negatively affecting long-term survival. The paper also discusses recent findings on the causes, risk factors, diagnosis, treatment, and prognosis of ACR. It highlights new potential biomarkers, which are being studied for their ability to improve the diagnosis process of transbronial biopsies. The paper concludes by identifying areas where further research is needed.

FAQs

  1. What is acute cellular rejection (ACR) and how common is it after a lung transplant?
  2. What are the potential risks associated with persistent or recurring ACR after a lung transplant?
  3. What are the new potential biomarkers being studied to improve the diagnosis process of transbronial biopsies?

Doctor’s Tip

One helpful tip a doctor might tell a patient about lung transplant is to closely follow their medication regimen and attend all follow-up appointments. This is crucial for monitoring any signs of rejection or infection and making necessary adjustments to their treatment plan. It is also important for patients to maintain a healthy lifestyle, including regular exercise and a balanced diet, to support their overall lung health and recovery post-transplant.

Suitable For

Patients who are typically recommended for lung transplant include those with end-stage lung disease, such as:

  • Chronic obstructive pulmonary disease (COPD)
  • Idiopathic pulmonary fibrosis
  • Cystic fibrosis
  • Pulmonary hypertension
  • Bronchiectasis
  • Alpha-1 antitrypsin deficiency

These patients often have severe respiratory symptoms and declining lung function despite medical treatment, and a lung transplant may be the only option for improving their quality of life and survival. Additionally, patients who have experienced acute respiratory distress syndrome (ARDS) or severe lung injury due to trauma or infection may also be considered for a lung transplant if they have not responded to other treatments.

Timeline

  • Patient is diagnosed with end-stage lung disease and referred for lung transplant evaluation
  • Patient undergoes extensive medical and psychological evaluations to determine eligibility for transplant
  • Patient is placed on the transplant waiting list and waits for a suitable donor match
  • Patient receives the call that a donor match has been found and undergoes the lung transplant surgery
  • Patient is closely monitored in the hospital for any complications or signs of rejection
  • Patient begins a lifelong regimen of immunosuppressant medications to prevent rejection
  • Patient undergoes regular follow-up appointments and monitoring to track lung function and overall health
  • Patient may experience episodes of acute cellular rejection, which can be treated with medication adjustments or other interventions
  • Patient may develop chronic lung allograft dysfunction over time, leading to decreased lung function and potential need for re-transplantation
  • Patient continues to receive ongoing care and support from their transplant team to manage any complications and optimize long-term outcomes.

What to Ask Your Doctor

  1. What are the common complications or risks associated with a lung transplant, particularly in relation to acute cellular rejection?

  2. How can I minimize my risk of experiencing acute cellular rejection after a lung transplant?

  3. What symptoms should I watch for that may indicate a potential episode of acute cellular rejection?

  4. How is acute cellular rejection typically diagnosed and monitored post-transplant?

  5. What treatment options are available for acute cellular rejection, and what is the success rate of these treatments?

  6. Are there any new or experimental treatments for acute cellular rejection that I should be aware of?

  7. What are the potential long-term effects of experiencing acute cellular rejection episodes after a lung transplant?

  8. How often will I need to undergo monitoring or testing for signs of acute cellular rejection post-transplant?

  9. Are there any lifestyle changes or precautions I should take to help prevent episodes of acute cellular rejection?

  10. Are there any support groups or resources available for patients who have experienced acute cellular rejection after a lung transplant?

Reference

Authors: Renaud-Picard B, Koutsokera A, Cabanero M, Martinu T. Journal: Semin Respir Crit Care Med. 2021 Jun;42(3):411-427. doi: 10.1055/s-0041-1729542. Epub 2021 May 24. PMID: 34030203