BACKGROUND: Most lung transplant recipients experience improvement in their underlying pulmonary condition but are faced with the threat of allograft rejection, the primary determinant of long-term survival. Several studies examined predictors of rejection, but few focused on the early period after transplantation. OBJECTIVES: To describe the pattern and predictors of early rejection during the first year after transplantation to guide the development of interventions to facilitate earlier detection and treatment of rejection. METHODS: Data for donor, recipient, and posttransplant variables were retrieved retrospectively for 250 recipients of single or double lung transplants. RESULTS: Most recipients (85%) had at least 1 episode of acute rejection; 33% had a single episode; 23% had recurrent rejection; 3% had persistent rejection; 13% had refractory rejection; and 14% had clinicopathological evidence of chronic rejection. Serious rejection (refractory acute rejection or chronic rejection) developed in 27% of recipients. Compared with other recipients, recipients who had serious rejection had more episodes of acute rejection (P = .004), and the first acute episodes occurred sooner after transplantation (P = .01) and were of a higher grade (P = .002). CONCLUSIONS: Recipients who experienced higher grades for their first episode of acute rejection (P = .03) and higher cumulative rejection scores (P = .004) were significantly more likely than other recipients to have serious rejection during the first year after transplantation.
BACKGROUND: Most lung transplant recipients experience improvement in their underlying pulmonary condition but are faced with the threat of allograft rejection, the primary determinant of long-term survival. Several studies examined predictors of rejection, but few focused on the early period after transplantation. OBJECTIVES: To describe the pattern and predictors of early rejection during the first year after transplantation to guide the development of interventions to facilitate earlier detection and treatment of rejection. METHODS: Data for donor, recipient, and posttransplant variables were retrieved retrospectively for 250 recipients of single or double lung transplants. RESULTS: Most recipients (85%) had at least 1 episode of acute rejection; 33% had a single episode; 23% had recurrent rejection; 3% had persistent rejection; 13% had refractory rejection; and 14% had clinicopathological evidence of chronic rejection. Serious rejection (refractory acute rejection or chronic rejection) developed in 27% of recipients. Compared with other recipients, recipients who had serious rejection had more episodes of acute rejection (P = .004), and the first acute episodes occurred sooner after transplantation (P = .01) and were of a higher grade (P = .002). CONCLUSIONS: Recipients who experienced higher grades for their first episode of acute rejection (P = .03) and higher cumulative rejection scores (P = .004) were significantly more likely than other recipients to have serious rejection during the first year after transplantation.
Authors: Mary Amanda Dew; Andrea F Dimartini; Annette De Vito Dabbs; Rachelle Zomak; Sabina De Geest; Fabienne Dobbels; Larissa Myaskovsky; Galen E Switzer; Mark Unruh; Jennifer L Steel; Robert L Kormos; Kenneth R McCurry Journal: Transplantation Date: 2008-01-27 Impact factor: 4.939
Authors: A E Gelman; M Okazaki; S Sugimoto; W Li; C G Kornfeld; J Lai; S B Richardson; F H Kreisel; H J Huang; J R Tietjens; B H Zinselmeyer; G A Patterson; M J Miller; A S Krupnick; D Kreisel Journal: Am J Transplant Date: 2010-05 Impact factor: 8.086
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Authors: Anthony W Castleberry; Muath Bishawi; Mathias Worni; Loretta Erhunmwunsee; Paul J Speicher; Asishana A Osho; Laurie D Snyder; Matthew G Hartwig Journal: Ann Thorac Surg Date: 2016-09-10 Impact factor: 4.330
Authors: Chetan Naik; Cody Moore; Matthew Pipeling; Jonathan D'Cunha; Kristine Ruppert; Christopher Ensor; Matthew Morrell Journal: Transplant Direct Date: 2018-04-26