Transplant and Pulmonary Hypertension

Transplant Rejection

Eighty to eighty-five percent of those who survive the transplant operation have a good functional status afterward and can do normal activities without difficulty. There is a small percentage of transplant recipients, however, who experience complications post-transplant. One of the most common complications in transplant recipients is rejection of the donated organ(s).

Rejection is the tendency of your body’s immune system to try to rid your body of your new organ because it is different from “you”; your immune system sees the new organ as an invader in the same way that it sees germs as invaders. Lungs are more likely than most organs to prompt this response, so rejection is more of a problem. In fact, episodes of rejection are expected, so do not be too alarmed if your doctor tells you that you are experiencing a rejection. You will be given medication to reduce the chances of rejection, and if you experience a rejection episode, your doctor will adjust your medications to treat it.

There are two types of organ rejection:

  • Acute rejection can happen at any time, but is most common during the first month after transplant. When treated early, it is curable.
  • Chronic rejection involves the formation of nodular masses in the lungs. These masses lodge in the small air passages in the lungs and reduce the ability to breathe normally. Chronic rejection can only be cured with re-transplantation.

Because rejection often has no initial symptoms, you will need regular lung biopsies to check the status of your new organ. It can be strange to be feeling good — better than you remember ever feeling — and then have your doctor tell you that your breathing tests and your lung biopsy show rejection. When you have been sick for a long time with a disease you are familiar with, you have to relearn what is “normal” so you can tell when your new lungs are not functioning properly. This can be scary, but you can learn to recognize the symptoms, when to call the doctor and when to get to the hospital.

Symptoms of rejection include:

  • Fever
  • Shortness of breath
  • Decreased exercise tolerance
  • Decrease in FEV1 and FVC

Treatment of rejection involves three daily doses of an intravenous form of Prednisone called Methylprednisolone or Solu-Medrol. This may occur in the hospital or, if you are feeling well enough, at home. After the third dose of Solu-Medrol, your doctor will increase your oral Prednisone medication and then taper it back down as the rejection ceases.