Bronchiolitis Obliterans in Lung Transplant Recipients with Non-Minimal Acute Cellular Rejection

Lung transplant recipients who are found to have non-minimal acute cellular rejection or lymphocytic bronchiolitis on biopsy represent a population at significant risk for the development of bronchiolitis obliterans syndrome. Identifying and acting on these histological findings is a key step in protecting long-term allograft function.

Clinical Scenario

Lung transplant recipients with non-minimal acute cellular rejection (Grade ≥A2) or lymphocytic bronchiolitis identified on transbronchial lung biopsy specimens. These findings indicate a degree of alloimmune injury that warrants active intervention to reduce the risk of subsequent bronchiolitis obliterans syndrome (BOS).

Treatment Approach

The recommended approach involves augmenting the patient's immunosuppression with a course of systemic corticosteroids — the aim being to suppress the ongoing rejection process and prevent progression to BOS.

Full protocol details — including agent selection, dosing strategy, and clinical monitoring — are in the complete structured regimen.

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References

For lung transplant recipients who have non-minimal acute cellular rejection (Grade ≥A2) or lymphocytic bronchiolitis on transbronchial lung biopsy specimens, we suggest augmented immunosuppression with a course of systemic steroids to prevent the development of BOS (conditional recommendation, very low quality evidence).

A typical course of systemic corticosteroids used to augment immunosuppression in adult recipients is intravenous methylprednisolone 1000 mg daily for 3 days (many centres use 10–15 mg·kg⁻¹ per day for smaller patients).

DOI: 10.1183/09031936.00107514

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