Why so many medications?

Your body’s immune system sees your new lung as “foreign” and may try to reject it. To prevent this, you’ll take immunosuppressants – drugs that help your immune system accept the new lung.

You’ll also take medications to prevent infections and manage side effects like high blood pressure, nausea or fluid buildup.

After your transplant, it will be important to stay up to date on all your routine vaccinations each year. These vaccines help protect you from infections while your immune system is suppressed. Your transplant team will guide you on which vaccines you need and when to get them .

Common immunosuppressants

Not everyone has all side effects. Your team will help manage them and adjust your dose if needed.

Other medications:

• Antibiotics to prevent infections.
• Anti-virals to prevent viruses.
• Antifungals to prevent fungal infections.
• Diuretics to reduce swelling.
• Stomach acid reducers.

Tips for managing medications

• Take your meds exactly as directed.
• Keep a list of everything you take.
• Store medicines properly.
• Set reminders or use a pill organizer.
• Talk to your team if you miss a dose or have side effects.

Post-transplant complications

Transplant recipients may experience different complications post-transplant. Infection and rejection are the most common complications. Infections are most common within the first year, but can occur at any time. There are different types of lung rejection, some happen early on (acute rejection) and others can develop or progress over time (chronic lung allograft dysfunction (CLAD).

Transplant Rejection

Rejection happens when your immune system sees your new lung as foreign and tries to attack it. This is one of the most common risks after transplant – but it can often be managed with therapies.

Is rejection normal?

Yes. Some level of rejection is expected. That’s why you take immunosuppressants – to lower the risk. Even so, your team will watch closely for signs of rejection through regular tests and biopsies. These regular lung biopsies through a bronchoscope will check the status of your lungs,

Types of rejection

• Acute rejection
  • Can happen at any time, but most often within the first two years.
  • Usually treatable if detected early and treated.
  • Most often diagnosed by biopsy.
• Chronic Lung Allograft Dysfunction (CLAD)
  • Develops and progresses over time usually after the first year post transplantation.
  • Early detection is important to guide treatment.
  • Most often detected by progressive decline in pulmonary function tests.

Signs of rejection

Call your transplant team if you notice:

• Shortness of breath especially with exercise.
• Feeling more tired than usual.
• Sometimes you may have a low-grade fever.
• Lower numbers on your lung function tests (FEV1).

Sometimes, you might feel fine even if your tests show rejection – that’s why regular checkups and biopsies are so important.

How is rejection treated?

Depending on the type of rejection that is found, the medical team may:

• Give you high-dose IV steroids like Solu-Medrol.
• Increase your oral prednisone.
• Adjust your other medications.
• Initiate other therapies.

Treatment may be done in the hospital or at home, depending on how you feel and what your team recommends.

Treatment of acute rejection often involves three daily doses of an intravenous form steroids 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.