Duke's lung transplant team fights rejection of transplanted lungs very aggressively through the use of steroids, RATG, and Campath.

Steroids

Treatment of rejection usually consists of three daily doses of an intravenous steroid drug called methylprednisolone. This drug is also known as Solu-Medrol and is an intravenous form of prednisone.

If you are not feeling well, you may be admitted to the hospital to receive the Solu-Medrol. However, if you are having no symptoms, we will arrange for a home care company to give you your Solu-Medrol at home.

When you have received the third dose of Solu-Medrol, we will increase your dose of prednisone and taper it by five milligrams daily until you are back to baseline.

Rabbit Anti-Thymocyte Globulin (RATG)

If rejection is extremely severe, or if it persists after you receive Solu-Medrol and the prednisone taper, a preparation called rabbit anti-thymocyte globulin (RATG or Thymoglobulin) may be used.

As its name implies, RATG is prepared from the serum (part of the blood) of rabbits. It contains powerful antibodies against human rejection cells, and must be given in a hospital setting.

You will receive three or five daily doses of RATG intravenously while you are in the hospital. The first dose often causes uncomfortable side effects such as fever, aches, nausea/vomiting, and low blood pressure.

Your nurse will monitor your vital signs very frequently while you are receiving the RATG. Side effects are usually much less severe after the first dose.

Because the RATG works by weakening your immune system even further than your maintenance anti-rejection drugs, you will be even more likely to develop infections for a while after receiving this therapy.

Be extra careful to avoid exposing yourself to infection, and as a precaution against CMV infection, you will receive ganciclovir intravenously for three weeks after receiving your RATG therapy.

A long-term IV line (PICC line) will be inserted in your arm while you are in the hospital, so that you can finish the three-week course of ganciclovir at home.

Campath

If rejection persists after treatment with both steroids and RATG, you may receive a drug called Campath to treat the rejection. Campath is an extremely powerful anti-rejection drug that is only given in a hospital setting.

You will receive just one dose of Campath, but its effect on your immune system will last a very long time. After receiving your dose of Campath, you will need to take medication to prevent both CMV infection and fungus infection for a very long time.

Because these drugs are very expensive, and you will need to stay on them for a long time (often years, until your immune system’s function returns), we will check your insurance coverage of the drugs to prevent fungus and CMV infection prior to scheduling your hospital admission for Campath.