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Treatment of presumed and proven acute rejection following six months of lung transplant survival.
Am J Respir Crit Care Med. 1995 Oct; 152(4 Pt 1):1321-4.AJ

Abstract

The gold standard for the diagnosis and subsequent treatment of acute rejection of lung allografts is the demonstration of rejection on transbronchial biopsy specimens. However, treatment may be initiated in the case of a compatible clinical scenario in the absence of definitive histologic documentation. In the Toronto Lung Transplant Program, we have treated patients with a decline in FEV1 and no evidence of infection with augmented systemic steroids for a presumed diagnosis of rejection. We retrospectively reviewed all episodes of acute rejection that occurred beyond 6 mo after transplant where treatment with augmented steroids had been initiated. A total of 72 treatments with augmented steroids were initiated in 45 patients who underwent 47 transplant procedures. FEV1 showed at least a 10% improvement following steroids in 14 of 72 (19%). FEV1 continued to decline by at least 10% in 32 of 72 (44%). Changes in FEV1 between +10 and -10% occurred in 26 of 72 (36%); of those episodes, 19 showed a decline of < 10%. Histologic evidence of at least grade II rejection was documented in only 16 cases. In those cases, FEV1 improved by at least 10% in 7 of 16 (44%), whereas it declined by at least 10% in 4 of 16 (25%). Spirometric evidence of bronchiolitis obliterans syndrome developed within 3 mo of the treated rejection episode in at least 20 of 47 transplants (43%). We conclude that treatment with augmented systemic steroids for presumed and histologically proven acute rejection beyond 6 mo after transplant is often ineffective in improving spirometry.

Authors+Show Affiliations

Toronto Lung Transplant Program, University of Toronto, Ontario, Canada.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

7551389

Citation

Kesten, S, et al. "Treatment of Presumed and Proven Acute Rejection Following Six Months of Lung Transplant Survival." American Journal of Respiratory and Critical Care Medicine, vol. 152, no. 4 Pt 1, 1995, pp. 1321-4.
Kesten S, Maidenberg A, Winton T, et al. Treatment of presumed and proven acute rejection following six months of lung transplant survival. Am J Respir Crit Care Med. 1995;152(4 Pt 1):1321-4.
Kesten, S., Maidenberg, A., Winton, T., & Maurer, J. (1995). Treatment of presumed and proven acute rejection following six months of lung transplant survival. American Journal of Respiratory and Critical Care Medicine, 152(4 Pt 1), 1321-4.
Kesten S, et al. Treatment of Presumed and Proven Acute Rejection Following Six Months of Lung Transplant Survival. Am J Respir Crit Care Med. 1995;152(4 Pt 1):1321-4. PubMed PMID: 7551389.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of presumed and proven acute rejection following six months of lung transplant survival. AU - Kesten,S, AU - Maidenberg,A, AU - Winton,T, AU - Maurer,J, PY - 1995/10/1/pubmed PY - 1995/10/1/medline PY - 1995/10/1/entrez SP - 1321 EP - 4 JF - American journal of respiratory and critical care medicine JO - Am. J. Respir. Crit. Care Med. VL - 152 IS - 4 Pt 1 N2 - The gold standard for the diagnosis and subsequent treatment of acute rejection of lung allografts is the demonstration of rejection on transbronchial biopsy specimens. However, treatment may be initiated in the case of a compatible clinical scenario in the absence of definitive histologic documentation. In the Toronto Lung Transplant Program, we have treated patients with a decline in FEV1 and no evidence of infection with augmented systemic steroids for a presumed diagnosis of rejection. We retrospectively reviewed all episodes of acute rejection that occurred beyond 6 mo after transplant where treatment with augmented steroids had been initiated. A total of 72 treatments with augmented steroids were initiated in 45 patients who underwent 47 transplant procedures. FEV1 showed at least a 10% improvement following steroids in 14 of 72 (19%). FEV1 continued to decline by at least 10% in 32 of 72 (44%). Changes in FEV1 between +10 and -10% occurred in 26 of 72 (36%); of those episodes, 19 showed a decline of < 10%. Histologic evidence of at least grade II rejection was documented in only 16 cases. In those cases, FEV1 improved by at least 10% in 7 of 16 (44%), whereas it declined by at least 10% in 4 of 16 (25%). Spirometric evidence of bronchiolitis obliterans syndrome developed within 3 mo of the treated rejection episode in at least 20 of 47 transplants (43%). We conclude that treatment with augmented systemic steroids for presumed and histologically proven acute rejection beyond 6 mo after transplant is often ineffective in improving spirometry. SN - 1073-449X UR - https://www.unboundmedicine.com/medline/citation/7551389/Treatment_of_presumed_and_proven_acute_rejection_following_six_months_of_lung_transplant_survival_ L2 - http://www.atsjournals.org/doi/full/10.1164/ajrccm.152.4.7551389?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -