Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jan;20(1):241-249.
doi: 10.1111/ajt.15561. Epub 2019 Sep 6.

The impact of first untreated subclinical minimal acute rejection on risk for chronic lung allograft dysfunction or death after lung transplantation

Liran Levy  1 , Ella Huszti  2 , Jussi Tikkanen  1 , Rasheed Ghany  1 , William Klement  1 , Musawir Ahmed  1 , Shahid Husain  3 , Pierre O Fiset  4 , David Hwang  4 , Shaf Keshavjee  1 , Lianne G Singer  1 , Stephen Juvet  1 , Tereza Martinu  1
Affiliations
Free article

The impact of first untreated subclinical minimal acute rejection on risk for chronic lung allograft dysfunction or death after lung transplantation

Liran Levy et al. Am J Transplant. 2020 Jan.
Free article

Abstract

Acute cellular rejection (ACR) is a significant risk factor for chronic lung allograft dysfunction (CLAD). Although clinically manifest and higher grade (≥A2) ACR is generally treated with augmented immunosuppression, management of minimal (grade A1) ACR remains controversial. In our program, patients with subclinical and spirometrically stable A1 rejection (StA1R) are routinely not treated with augmented immunosuppression. We hypothesized that an untreated first StA1R does not increase the risk of CLAD or death compared to episodes of spirometrically stable no ACR (StNAR). The cohort was drawn from all consecutive adult, first, bilateral lung transplantations performed between 1999 and 2017. Biopsies obtained in the first-year posttransplant were paired with (forced expiratory volume in 1 second FEV1 ). The first occurrence of StA1R was compared to a time-matched StNAR. The risk of CLAD or death was assessed using univariable and multivariable Cox proportional hazards models. The analyses demonstrated no significant difference in risk of CLAD or death in patients with a first StA1R compared to StNAR. This largest study to date shows that, in clinically stable patients, an untreated first A1 ACR in the first-year posttransplant is not significantly associated with an increased risk for CLAD or death. Watchful-waiting approach may be an acceptable tactic for stable A1 episodes in lung transplant recipients.

Keywords: acute rejection; chronic lung allograft dysfunction; clinical research/practice; lung transplantation/pulmonology; rejection: acute; rejection: chronic; rejection: subclinical; risk assessment/risk stratification.

PubMed Disclaimer

References

REFERENCES

    1. Yusen RD, Edwards LB, Dipchand AI, et al. The registry of the international society for heart and lung transplantation: thirty-third adult lung and heart-lung transplant report-2016; focus theme: primary diagnostic indications for transplant. J Heart Lung Transplant. 2016;35(10):1170-1184.
    1. Koutsokera A, Levy L, Pal P, Orchanian-Cheff A, Martinu T. Acute cellular rejection: is it still relevant? Semin Respir Crit Care Med. 2018;39(2):181-198.
    1. Glanville AR, Aboyoun CL, Havryk A, Plit M, Rainer S, Malouf MA. Severity of lymphocytic bronchiolitis predicts long-term outcome after lung transplantation. Am J Respir Crit Care Med. 2008;177(9):1033-1040.
    1. Girgis RE, Tu I, Berry GJ, et al. Risk factors for the development of obliterative bronchiolitis after lung transplantation. J Heart Lung Transplant. 1996;15(12):1200-1208.
    1. Sharples LD, McNeil K, Stewart S, Wallwork J. Risk factors for bronchiolitis obliterans: a systematic review of recent publications. J Heart Lung Transplant. 2002;21(2):271-281.

Publication types

MeSH terms