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

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my brother is in the hospital in indianapolis,ind. stage three rejection of a lung transplant 5 years ago. what are his changes,

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 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.
  • ... 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'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,

Daniel Nelson, MD and 2 other Health Specialists are ready to help you
Customer: replied 9 years ago.
Dr.Nelson, Thank you so much for your help! I will try and get the information from charle's Doctor's.

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.