Lung Transplant Rejection

The two main complications of transplant surgery are organ rejection and infection. Since the body recognizes the new lung as a foreign object, it will normally try to get rid of it or "reject" it. Anti-rejection drugs taken after surgery help prevent a rejection episode, but they also inhibit part of the immune system. Since the body's ability to fight infection is decreased, transplant recipients are more prone to infections.

Years of experience, research, and improved medicines help prevent rejection, and your transplant team will take every precaution to prevent these complications. While you are recovering in the hospital, you will learn to recognize signs of rejection and infection.

What is transplant rejection?
The body's immune system protects you from infection. Immune cells recognize the transplanted lung as different from the rest of the body and attempt to destroy it. This is called rejection, and it is your body's way of not accepting the new organ.

After transplant surgery, you are prescribed immunosuppressive drugs to "fool" your immune system into thinking your new lung is your own so it doesn't try to attack it.

Although rejection is most common in the first six months after surgery, it can occur at any time. Fortunately, rejection can be treated, especially if the signs of rejection are recognized early. While you are in the hospital, your transplant team can usually recognize a rejection episode before it causes any major or irreversible damage.

After you go home, it is vital for you to be aware of the possible signs of rejection so you can report them to your health care providers and be treated immediately. It is also very important for you to continuously take your medicines as prescribed, have your blood work drawn as scheduled, and follow your pulmonary function test and bronchoscopy schedules.

What are the warning signs of possible rejection?
If you are experiencing any of these symptoms, contact your transplant coordinator immediately:

• Fever over 100°F (38°C)
• "Flu-like" symptoms: chills, aches, headache, dizziness, nausea and/or vomiting
• Chest congestion
• Cough
• Shortness of breath
• New pain or tenderness around the lung
• Fatigue or generally feeling "lousy"

• Repeated blood work including a complete blood count
• Bronchoscopy
• Lung biopsy and surveillance bronchoscopy — These tests are performed routinely as part of your follow-up care (at three weeks, six weeks, three months, six months, nine months, and one year after transplant surgery)

How is rejection treated?
If rejection develops, your doctor will prescribe medicine to treat rejection and prevent continued complications. In order to control the rejection, you might need to be admitted to the hospital, or you might receive care in an outpatient setting.

Will rejection treatment cause side effects?
The medicines used to treat a lung rejection episode are strong drugs. The first few doses might cause the following side effects:

• Fever, chills
• Headaches
• Nausea, vomiting
• Weakness
• Diarrhea
• General flu-like symptoms

In order to help control these symptoms, you will receive a pre-medication of acetaminophen (Tylenol) and diphenhydramine hydrochloride (Benadryl) before each dose.

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