Lung nontumor
Other nonneoplastic disease
Transplantation / rejection

Topic Completed: 1 December 2011

Minor changes: 27 May 2020

Copyright: 2003-2020,, Inc.

PubMed search: pulmonary transplantation [title]

Elliot Weisenberg, M.D.
Page views in 2019: 556
Page views in 2020 to date: 211
Cite this page: Weisenberg E. Transplantation / rejection. website. Accessed May 28th, 2020.
Clinical features
  • Lung transplantation is the only effective treatment for severe idiopathic pulmonary fibrosis, primary pulmonary hypertension, emphysema and cystic fibrosis
  • For cystic fibrosis, both lungs are removed, even if only one replaced, to minimize infectious complications
  • Despite clinical challenge, outcomes have improved due to better surgery and management
  • Overall 1 year survival is 78%, 5 year 50% and 10 year 26%
  • Recipient lung may be infected by CMV, Pneumocystis, fungi or bacteria, due to immunosuppression

Acute rejection:
  • Weeks to months after transplant, occurs in nearly all patients to some extent
  • Fever, shortness of breath, cough and chest xray abnormalities
  • Diagnose with transbronchial biopsy

Chronic rejection:
  • Affects at least 50% of patients by 3 - 5 years after surgery
  • Clinically shortness of breath and cough
  • Histologic correlate is bronchiolitis obliterans, but lesion may be patchy; may also have pulmonary fibrosis and bronchiectasis
  • Open lung biopsy (versus transbronchial biopsy) may be necessary for diagnosis
  • No effective treatment

Post bone marrow transplantation injury in lung:
  • Graft versus host disease and interstitial pneumonia cause most nonleukemic deaths
  • Pneumonia typically is caused by CMV
  • Pneumonitis is caused by chemotherapy and radiation injury

Post lung transplant lymphoproliferative disorder (PTLD):
  • Relatively high levels of immunosupression relative to other solid organs increases risk
  • Incidence is 3%, with a median of 7 months to development of disease (Mod Pathol 2002;15:647)
  • B cell lineage, 78% are EBV+, all monoclonal and usually in lung
  • Most die at a mean of 5 months
Microscopic (histologic) description
  • Chronic inflammatory infiltrate around small vessels or in submucosa of airways
  • Treat with immunosuppression
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