Abstract
2121672). There were 78 episodes of acute rejection, 29 in 13 DR patients (2.2 episodes/patient), and 49 in 21 NR patients (2.3 episodes/patient). ISHLT grades in 38 biopsies were A1 (9), A2 (19), A3 (8), lymphocytic bronchiolitis (1), acute rejection 1 cytomegalovirus (1). Multiple, often recurrent infections caused by a wide spectrum of organisms occurred in 13 DR patients (81.3%) and in 24 NR patients (82.8%). Nine patients (3 DR, 6 NR) developed obliterative bronchiolitis, causing death in 5 patients (1 DR, 4 NR). Fifteen patients (33.3%) died, 4 (25%) of 16 with DR and 11 (37.9%) of 29 with NR. In 1 DR patient death was due to sarcoidosis in the graft and the native lung. Mean time to death after tx for DR was 1483 days (6423280) and for NR was 1128 days (3222547). Mean time to death after DR was 1227 days (33-3155). Our findings of DR in 16 (35.5%) of 45 patients surviving . 30 days after tx is probably conservative given the limitations of our study. Although the frequency of acute rejection and infections is similar in both groups, DR may confer a slight survival advantage due to better control of subclinical rejection which warrants further study.
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