Detecting Acute Lung Rejection and Infection Following Heart-Lung Transplantation
The benefits of lung transplantation are compromised by two common acute complications: acute lung rejection, and opportunistic infection. The lungs are a common site for these disorders. Chronic lung rejection appears to cause obliterative bronchiolitis, which has been reported to cause disability and death in up to 50 percent of long-term heart-lung transplant (HLT) recipients.
Various clinical investigations have been used to monitor the lungs for acute rejection and infection. They include chest radiology, measurement of “”Tc- DTPA clearance of the lung, pulmonary function testing, and more recently transbronchial lung biopsy (TBB). Transbronchial lung biopsy is currently the most sensitive and specific test for lung rejection and allows the distinction between infection and rejection to be made. However, it required fiberoptic bronchoscopy which, while easily repeated, is not a procedure that can be undertaken daily.
Previously we reported the value of laboratory lung function testing, in particular forced expiratory volume in 1 s (FEV\) and forced vital capacity (FVC), in detecting acute lung rejection and infection, thereby facilitating a decision as to when TBB should be performed. As regular daily spirometry at home is now possible using a battery-operated spirometer, we decided to monitor pulmonary function in this way so as to allow early detection of rejection and infection. The results of a prospective study of this monitoring form the basis of this report. viagra plus
