CHRONIC REJECTION FOLLOWING LUNG TRANSPLANTATION - INCIDENCE, TIME-PATTERN AND CONSEQUENCES

The long-term prognosis following lung transplantation (LTX) depends m ainly on the development of chronic rejection which appears clinically as deterioration of the lung function while, histologically, oblitera tive bronchiolitis (OB) is found. However, it still remains questionab le whether heart-lung (HL), double or single lung (DL/SL) transplants behave similarly with regard to incidence and time pattern. Eighty-two patients, transplanted until August 92, were analyzed. Early and late deaths within 180 days postoperatively were excluded. A total of 64 p atients at risk could be evaluated. By repeated lung function tests, o bstructive airway disease was defined by a drop of 25% or more of the forced expiratory volume in one second (FEV1) in percent of the inspir atory vital capacity. Results: The functional optimum after transplant ation was reached after a comparable time-span postoperatively in all groups. Chronic deterioration of the lung function developed earlier f ollowing DLTX compared to HLTX and SLTX. Obstructive airway disease wa s diagnosed in 9/20 (45%) HL, 7/19 (37%) DL, and 7/25 (28%) SL patient s. Of these, 4 died and 4 had to be retransplanted for the disease whi le an additional 15 patients are currently under investigation. It is concluded that the development of obstructive airway disease represent s a serious problem in all types of lung transplantation. There is a t endency to earlier development following DLTX - perhaps caused by the greatest immunological potential in this group of patients.