Rejection of your transplanted lung(s) can occur at any time following your surgery. Episodes of rejection most commonly occur during the first 12 months after transplant.

Try not to become too alarmed if you are told that you are experiencing rejection. Episodes of rejection are common, and other than taking your immunosuppressive medications, there is nothing you can do to prevent them from happening.

Rejection is easily treated if it is detected early. For this reason, it is important for you to be able to recognize signs and symptoms of rejection. These include:

• Fever
• Shortness of breath
• Decreased exercise tolerance
• Decrease in FEV1 and FVC (Learn more about these measurements)

Very often, rejection will occur without any symptoms that you can detect. For this reason, we will biopsy your transplanted lung at regular intervals.

Diagnosing Rejection

After your transplant, you will have a biopsy of your transplanted lung(s) at regular intervals to check for the presence of rejection. Biopsies will be done at one month, three months, six months, nine months, 12 months, and then just once a year unless there is a problem with your lungs.

Biopsies are done through a lighted tube, called a bronchoscope, that is inserted through your nose or mouth and into your transplanted lung(s).

You will receive instructions prior to each bronchoscopy that will detail eating and medication restrictions.

The bronchoscopy will be done in a special procedure room, and you will be given medication to help you relax before your biopsy if necessary. Your throat will then be sprayed with a numbing medication, and the bronchoscope will be inserted through your nose or mouth. Insertion of the bronchoscope is normally uncomfortable and will make you cough.

You will be monitored closely throughout the procedure, so try to relax as much as you can.

After your doctor has carefully examined your lungs through the bronchoscope, several tiny pieces of lung tissue will be removed. When the biopsy is finished, you will be required to remain in bed with nothing to eat or drink for the next two hours.

You will always need to bring someone with you who can be responsible for driving you home after the bronchoscopy, since you will be unable to drive after receiving the medication to help you relax.

The tissue from your biopsy will be taken to a special laboratory, where it is examined carefully under a microscope for the presence of rejection and infection. You will usually be notified of the results of your biopsy in 48 to 72 hours. If rejection is present, your coordinator will explain the plan for treatment.

Bronchiolits Obliterans Syndrome (BOS)/Chronic Rejection

Bronchiolits obliterans syndrome (BOS) is a term that refers to progressive deterioration in the function of a transplant lung(s) in the absence of reversible causes.

Unlike acute rejection, it  doesn’t respond to currently available medical treatment. It may be related to repeated infections or rejection episodes. Unfortunately, BOS is common in lung transplant recipients and the most common cause of death.

We have an active research program focused on better understanding, preventing, and treating BOS.

If you develop BOS, we will do our best to stabilize and maintain the function of your transplanted lung(s) for as long as possible. This usually involves changing some of your immunosuppressive drugs or adding other drugs such as azithromycin.

You may be considered for another lung transplant in certain circumstances. It is of utmost importance that you take the best possible care of yourself, report any signs or symptoms of rejection and infection as early as possible, and carefully follow the instructions of the lung transplant team, which are designed to help you avoid the development of BOS.