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:
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.
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
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.
-- XXXXX XXXXX, MD