Acute rejection and post lung transplant surveillance

subramani, M. Venkata; Pandit, Sumir; Gadre, Shruti

doi:10.1007/s12055-021-01320-z

Cited by 10 publications

(8 citation statements)

References 45 publications

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“…Rejection continues to be a significant barrier to long term survival in lung transplantation. Nearly 30% of lung transplant recipients are reported to experience at least one episode of acute rejection during the first postoperative year, with severity and frequency reported as a major cause of CLAD [120,126,127]. As mentioned previously, an immunosuppressive maintenance immunosuppressive regimen is crucial to is prevention, however at the cost of increased risk of an infection which is also an important risk factor of acute rejection [126].…”

Section: Detection Of Rejectionmentioning

confidence: 99%

“…Nearly 30% of lung transplant recipients are reported to experience at least one episode of acute rejection during the first postoperative year, with severity and frequency reported as a major cause of CLAD [120,126,127]. As mentioned previously, an immunosuppressive maintenance immunosuppressive regimen is crucial to is prevention, however at the cost of increased risk of an infection which is also an important risk factor of acute rejection [126]. Recipients experiencing acute rejection can present sub-clinically or clinically with dyspnea, cough, sputum production, and pyrexia.…”

Section: Detection Of Rejectionmentioning

confidence: 99%

“…Recipients experiencing acute rejection can present sub-clinically or clinically with dyspnea, cough, sputum production, and pyrexia. Acute rejection is often diagnosed based on the presence of perivascular and interstitial mononuclear cell infiltrates in lung tissue, requiring repeated surveillance transbronchial biopsies along with its inherent risks [120,126,127]. Histopathologic grading of acute rejection ranges from A0 (none) to A4 (severe), which is described as diffuse perivascular, interstitial, and air-space infiltrates of mononuclear cells; alveolar pneumocyte damage and endothelialitis [128].…”

Section: Detection Of Rejectionmentioning

confidence: 99%

“…Chronic Lung allograft Dysfunction (CLAD) remains the most fearful diagnosis in lung transplant recipients. It is the leading cause of death after the first year, reported to develop in as many as 50% of recipients in 5 years [126,127,132]. CLAD is defined by the ISHLT as a persistent decline in forced expiratory volume (FEV1), ≥20% from baseline for at least 3 months [132][133][134].…”

Section: Detection Of Rejectionmentioning

confidence: 99%

See 3 more Smart Citations

A Breath of Fresh Air - Lung Transplantation Has Come of Age

Keshavamurthy¹,

Russell²

2023

OBM Transplant

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A boundless spectrum of chronic lung diseases is said to effect over 500 million persons globally. Lung transplantation is a well-established therapeutic option for patients suffering from end-stage lung diseases, however waitlist mortality and primary graft failure remain major determinants as post-transplantation 5-year survival is just above 50 percent. Recent innovations in lung transplantation have been aimed at increasing organ availability, improving allograft quality, function, and longevity. Ex-vivo Lung Perfusion (EVLP) is an exciting modality responsible for multiple paths of lung allograft reconditioning as well as significantly extending preservation times. Mechanical circulatory support (MCS), specifically extracorporeal membrane oxygenation (ECMO) has consistently gained popularity not only for its use as a bridge to transplantation, but also its intraoperative role. In tandem, EVLP and ECMO have shown promising results in increasing the number of lung transplantations performed, therefore decreasing waitlist mortality. Primary graft dysfunction (PGD) and chronic lung allograft rejection (CLAD) continue to be the most feared predictors of poor outcomes. In this review we will highlight the historical progression of lung transplantation, its encumbrance, and the most recent advancements in promising techniques for long-term allograft protection and patient survival.

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Section: Detection Of Rejectionmentioning

confidence: 99%

Section: Detection Of Rejectionmentioning

confidence: 99%

Section: Detection Of Rejectionmentioning

confidence: 99%

Section: Detection Of Rejectionmentioning

confidence: 99%

See 2 more Smart Citations

A Breath of Fresh Air - Lung Transplantation Has Come of Age

Keshavamurthy¹,

Russell²

2023

OBM Transplant

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“…ACR is common and can increase the risk for CLAD. Surveillance TBB (performed in the absence of symptoms) in the early posttransplant period is a common practice, and up to 25% of these may show early ACR [9]. Treatment of asymptomatic ACR may help prevent CLAD theoretically, however this has not been well established and studies do not clearly display a survival benefit with this approach [10,11].…”

Section: Key Pointsmentioning

confidence: 99%

Acute rejection post lung transplant

Hanks,

Girard,

Sehgal

2024

Current Opinion in Pulmonary Medicine

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Purpose of Review To review what is currently known about the pathogenesis, diagnosis, treatment, and prevention of acute rejection (AR) in lung transplantation. Recent Findings Epigenomic and transcriptomic methods are gaining traction as tools for earlier detection of AR, which still remains primarily a histopathologic diagnosis. Summary Acute rejection is a common cause of early posttransplant lung graft dysfunction and increases the risk of chronic rejection. Detection and diagnosis of AR is primarily based on histopathology, but noninvasive molecular methods are undergoing investigation. Two subtypes of AR exist: acute cellular rejection (ACR) and antibody-mediated rejection (AMR). Both can have varied clinical presentation, ranging from asymptomatic to fulminant ARDS, and can present simultaneously. Diagnosis of ACR requires transbronchial biopsy; AMR requires the additional measuring of circulating donor-specific antibody (DSA) levels. First-line treatment in ACR is increased immunosuppression (pulse-dose or tapered dose glucocorticoids); refractory cases may need antibody-based lymphodepletion therapy. First line treatment in AMR focuses on circulating DSA removal with B and plasma cell depletion; plasmapheresis, intravenous human immunoglobulin (IVIG), bortezomib, and rituximab are often employed.

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Efficacy of a Standardized Regimen of Therapeutic Plasma Exchange and IVIG for Treatment of Antibody‐Mediated Rejection in Lung Transplant Recipients

Wodajo,

Sarode,

De Simone

et al. 2024

J of Clinical Apheresis

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Antibody‐mediated rejection (AMR) in lung transplantation has been associated with poor long‐term clinical course and is a risk factor for chronic lung allograft dysfunction and graft loss. Appropriate management of AMR is necessary to improve graft survival in lung transplant recipients. There is currently no standardized approach to the treatment of lung AMR, and practices vary by institution. We sought to examine the efficacy of a standardized protocol of plasma exchange (PLEX) and IVIG in decreasing donor‐specific antibodies (DSAs) and improving AMR in lung transplant recipients. A retrospective chart review was conducted on all lung transplant recipients who completed a course of PLEX per UT Southwestern AMR protocol between January 2012 and December 2019 for diagnosis of AMR. Data were collected on the patient clinical course, treatment regimen, pre‐PLEX DSA, post‐PLEX DSA, follow‐up (> 1‐month post‐PLEX) DSA, and pre‐and post‐PLEX biopsy, when available. Of 527 patients who underwent lung transplantation during the study period, 56 (11%) received an acute course of PLEX every other day per protocol for AMR of lung transplant. Forty (71%) of 56 patients had one episode of AMR requiring PLEX; 16 patients (29%) had repeat episodes of AMR within 6 weeks to 47 months of the first episode. Most patients showed improvement in AMR on biopsy (69%) and a decline in DSA (68%). Our data suggest that treatment with combined PLEX and IVIG protocol appears effective for treating lung AMR.

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Acute rejection and post lung transplant surveillance

Cited by 10 publications

References 45 publications

A Breath of Fresh Air - Lung Transplantation Has Come of Age

A Breath of Fresh Air - Lung Transplantation Has Come of Age

Acute rejection post lung transplant

Efficacy of a Standardized Regimen of Therapeutic Plasma Exchange and IVIG for Treatment of Antibody‐Mediated Rejection in Lung Transplant Recipients

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