title: Similarity of pulmonary rejection patterns among heart-lung and double-lung transplant recipients.
abstract: The transbronchial biopsy and clinical courses of 9 double-lung and 1 single-lung recipients surviving greater than 10 days were analyzed and compared to those of 15 heart-lung transplants performed during the same time period. Of these, 8 isolated lung (LT) and 11 heart-lung transplant (HLT) recipients survived greater than 50 days and were at risk of developing obliterative bronchiolitis believed to be a form of chronic rejection. Cyclosporine-based immunosuppression, in combination with azathioprine and steroids, was used for 22 of 25 patients. Two double-lung recipients and 1 heart-lung patient received FK506 as the sole immunosuppressive agent; 90% and 62% of LT, and 67% and 54% of HLT recipients developed acute and chronic rejection, respectively (P = NS). The average time to first episode of acute (30.2 days [LT] versus 21.5 days [HLT]) and chronic rejection (146 days [LT] versus 193.7 days [HLT]) was not different between groups (P = NS). Age (34.2 [LT] versus 29.1 [HLT]) and sex (M:F, 5:5 [LT] versus 5:10 [HLT]) were also not found to be discriminators. The histologic diagnosis of chronic rejection was associated with significant declines in FEV1.0 and FEF25-75 (P less than 0.02). There was only one instance of cardiac rejection among the heart-lung transplant recipients. Heart-lung and isolated lung transplant patients appear to be at similar risk for developing acute or chronic pulmonary rejection.
authors.affiliation: Department of Surgery, University of Pittsburgh, Pennsylvania 15261.
authors.forename: R J
authors.initials: RJ
authors.lastname: Keenan
authors.forename: P
authors.initials: P
authors.lastname: Bruzzone
authors.forename: I L
authors.initials: IL
authors.lastname: Paradis
authors.forename: S A
authors.initials: SA
authors.lastname: Yousem
authors.forename: J H
authors.initials: JH
authors.lastname: Dauber
authors.forename: R S
authors.initials: RS
authors.lastname: Stuart
authors.forename: B P
authors.initials: BP
authors.lastname: Griffith
mesh_terms: D000328:Adult; D005260:Female; D006084:Graft Rejection; D016041:Heart-Lung Transplantation; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D013997:Time Factors