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Acute rejection (T-lymphocyte rejection)

Around 60 percent of lung transplant recipients will experience an episode of acute rejection within the first year. Acute rejection is diagnosed by bronchoscopy results, a chest x-ray, and a drop in your forced expiratory volume (FEV1), the amount of air you can force out of your lungs in one second, of greater than 10 percent.  Your transplant team will tell you the symptoms to look for that may indicate acute rejection.

Treatment for acute rejection includes a high dose of corticosteroids, usually consisting of three daily doses of intravenous Solu-Medrol, which may be done in a hospital setting or at home, depending on how you feel and your doctor’s preference. It is usually followed by a prednisone taper over the next few weeks until you are back down to your baseline dose. Follow-up bronchoscopies may be done to determine whether the rejection is gone.

Unfortunately for some, treatment with corticosteroids may not rid your lungs of acute rejection. Other therapies that can be used if steroids do not help are cytolytic therapy such as rabbit anti-thymocyte globulin (RATG) or horse anti-thymocyte globulin. These are aggressive therapies designed to deplete your T-lymphocytes (which are the cause of most acute rejection episodes) and interfere with their normal function. If you need this therapy, you will be monitored in the hospital for the duration of the therapy (five to seven days).

There may be some uncomfortable side effects from this treatment. Your doctor will discuss these side effects with you and will also determine what prophylactic medications you may need to prevent infection following the treatment. Because depleting your T-lymphocytes weakens your immune system even further than your maintenance anti-rejection therapy, you will be at increased risk of infection for weeks to months following treatment.

You will need to take the necessary precautions to avoid exposing yourself to infection. If you are still experiencing acute rejection following steroid treatment and anti-thymocyte globulin therapy, you may receive a drug called Campath (alemtuzumab). Campath is an extremely potent medication that can only be given in a hospital setting. It is given as a one-time dose, and can cause many side effects. Prophylactic medications must be given for several months to years after the dose is given, and your immune system will be severely compromised for a long time. You must use extreme infection control following Campath. Your doctor will discuss with you the medications you will be taking, how to avoid infections, and how to identify side effects and symptoms of infection.

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