How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Daniel Nelson, MD Your Own Question

Daniel Nelson, MD
Daniel Nelson, MD, Doctor (MD)
Category: Health
Satisfied Customers: 258
Experience:  Licensed MD. Mayo Clinic Rochester trained physician in Internal Medicine - Critical Care Medicine.
8322836
Type Your Health Question Here...
Daniel Nelson, MD is online now
A new question is answered every 9 seconds

my brother is in the hospital in indianapolis,ind. stage ...

Customer Question

my brother is in the hospital in indianapolis,ind. stage three rejection of a lung transplant 5 years ago. what are his changes,
Submitted: 6 years ago.
Category: Health
Expert:  Daniel Nelson, MD replied 6 years ago.

Dear nightmvs,

I am very sorry to hear about your brother's lung transplant rejection. That's so much to go through for such a young man suffering through the ravages of Alpha-1-Antitrypsin Deficiency (AAT-deficiency).

If I am understanding your question correctly, you wish to know what his chances of survival are, correct? You used the word "changes," but I am only guessing that's a typo. You correct me if I am wrong. I will also work under the assumption that this was a bilateral lung transplant (BLT) and not a single lung transplant (SLT).

A lot of the terminology physicians use when they speak of acute (recent onset) or chronic (longer time present, or recurring problems) lung transplant rejection come from a 1996 revision of a 1990 classification and grading system established by the International Society for Heart and Lung Transplantation (ISHLT).

The classification and grading system looks at a very large number of factors, focusing however on the level of blood vessel inflammation and airway inflammation, injury, scarring, occlusion, and possible simultaneous infection(s). The survival prognosis, that is the percentage of patients surviving at intervals of days, to weeks, to months, to years depends not only upon the current rejection, but also the cumulative effects of past rejections and infections and the presence or absence of a complication called "Bronchiolitis Obliterans." The prognosis is also guided by many, many measurements of air flow rates and pressures, oxygen exchange in the lung, the ability to remove carbon dioxide from the lung, measurement of exhaled nitric oxide, lung volumes, lung blood vessel pressures, chest x-rays/CT scans ... the list is extensive, and there is no specific chances of survival that I can quote without all of these numbers, the complete 5-year post-transplant history of biopsies, rejections, infections, and pulmonary function testing results. I am sorry I can't make that estimate for you ...

What I do want to do, however, is tell you that I can detect how very much you care for and love your brother to go to our service here at JustAnswer.com to ask for our opinion. We are grateful for your trust in us to honour us with this opportunity to speak with you. It's very emotional for us, for me, to talk to you and not be able to answer your question with certainty. Your brother's critical care medicine / pulmonologists, and transplant surgeons can best answer this question straight up.

Questions you can ask the physicians include:

  • What is the ISHLT Classification and Grade of this rejection?
  • Does your brother have a co-existing infection right now?
  • Does your brother have chronic rejection underlying this acute episode?
  • Does your brother have a condition called "Bronchiolitis Obliterans?" If so, is it classified as active or inactive?
  • What are your brother's current chances of survival once he is past this acute rejection episode?
  • Should you or members of your family have genetic testing? If so, how and where can this be done? See also the Alpha-1 Association Website for more information about genetics and AAT-deficiency.
  • http://www.alpha1.org/ ... the actual web address for your reference. Their phone number is XXXXX

Now, excluding your brother and considering bilateral lung transplants as a whole in cases of Alpha-1-Antitrypsin Deficiency (AAT-deficiency), there are actuarial statistics (like those from insurance companies), and clinical statistics of quoted survival percentages in the setting of complications and personal circumstances.

  • 5-year survival is about 55-60% based on trends from a 1997 study by Trulock, EP, Am J Respir Crit Care Med 1997; 155:789.
  • Most causes of death at and beyond 5 years are due to Bronchiolitis Obliterans and Infection, especially in chronic rejection patients.
  • Approximately 60% of BLT patients are free from having Bronhiolitis Obliterans 5 years post-transplant. About 40% of BLT patients are free from Bronhiolitis Obliterans 10 years post-transplant.
  • Visit the Alpha-1 Association Website. There is a LOT of information there, and also in the section labelled Useful Links and Resources, several of which have to do with Transplantation.

Thank you for visiting JustAnswer.com's Health Information. I hope that all of your concerns have been addressed and that your experience here was positive and helpful. If you have a new or different question, please don't hesitate to come back or submit a new question. It has been a pleasure helping you. Your FEEDBACK is very important to me.

Kindest Regards,
XXXXX XXXXX, MD

Daniel Nelson, MD, Doctor (MD)
Category: Health
Satisfied Customers: 258
Experience: Licensed MD. Mayo Clinic Rochester trained physician in Internal Medicine - Critical Care Medicine.
Daniel Nelson, MD and 3 other Health Specialists are ready to help you
Customer: replied 6 years ago.
Dr.Nelson, Thank you so much for your help! I will try and get the information from charle's Doctor's.
Expert:  Daniel Nelson, MD replied 6 years ago.

I wish you, your family, and your brother all the best and will be thinking about you all often. Let me know what his physician's responses are to those questions. I am happy that I could help guide you or address your questions and concerns.

Daniel

--
XXXXX XXXXX, MD

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
< Last | Next >
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
  • I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!! Janet V Phoenix, AZ
 
 
 

Meet The Experts:

 
 
 
  • Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    4043
    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
< Last | Next >
  • http://ww2.justanswer.com/uploads/NU/nursescare4u/2013-3-31_03429_JApic.64x64.jpg Nurse Milli, RN's Avatar

    Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    4043
    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
  • http://ww2.justanswer.com/uploads/agketch/2008-7-14_184046_drketchresized.jpg Dr. Ketch's Avatar

    Dr. Ketch

    Doctor

    Satisfied Customers:

    102
    Medical Degree, Former Assistant Professor at School of Medicine at Yale University
  • http://ww2.justanswer.com/uploads/FA/FamilyPhysician/2013-8-31_191624_JA550x500Photo.64x64.jpg Family Physician's Avatar

    Family Physician

    Doctor (MD)

    Satisfied Customers:

    5622
    Emergency Medicine and Family Practice for over 26 years
  • http://ww2.justanswer.com/uploads/drphophalia/2007-08-23_095626_dr._arun_phophalia.jpg Dr. Arun Phophalia's Avatar

    Dr. Arun Phophalia

    Doctor (MD)

    Satisfied Customers:

    17025
    MBBS, MS (General Surgery), Fellowship in Sports Medicine
  • http://ww2.justanswer.com/uploads/VA/VANP/2012-6-6_235535_Skye2.64x64.jpg A. Schuyler, NP's Avatar

    A. Schuyler, NP

    Nurse Practitioner

    Satisfied Customers:

    12170
    Board Certified NP, MS, RN. Private practice & hospitalist
  • http://ww2.justanswer.com/uploads/TA/tazechip/2012-6-7_135230_drpic.64x64.png Dr. Chip's Avatar

    Dr. Chip

    Doctor (MD)

    Satisfied Customers:

    10029
    Over 20 yrs of Family Practice
  • http://ww2.justanswer.com/uploads/neurosurg/2009-10-06_120923_profile.jpg Dr. Mark's Avatar

    Dr. Mark

    Doctor (MD)

    Satisfied Customers:

    6234
    U.S. Physician/Surgeon in Neurosurgery