What is transplant rejection?

The body's immune system protects you from infection. Immune cells recognize the transplanted lung as different from the rest of the body and attempt to destroy it. This is called rejection, and it is your body's way of not accepting the new organ.

After transplant surgery, you are prescribed immunosuppressive drugs to "fool" your immune system into thinking your new lung is your own so it doesn't try to attack it.

Although rejection is most common in the first 12 months after surgery, it can occur at any time. Fortunately, rejection can be treated, especially if the signs of rejection are recognized early. While you are in the hospital, your transplant team can usually recognize a rejection episode before it causes any major or irreversible damage.

After you go home, it is vital for you to be aware of the possible signs of rejection so you can report them to your health care providers and be treated immediately. It is also very important for you to continuously take your medicines as prescribed, have your blood work drawn as scheduled, and follow your pulmonary function test and bronchoscopy schedules. After one year, it is important to continue to use your home spirometry unit to monitor your lung function since a decline of 10% can indicate rejection.

What are the risks of lung transplantation?

The risks of transplantation are the same as those of any surgery. Some of the risks include the risk of bleeding, infection, side effects related to the medications, rejection, kidney failure or, in rare cases, death.

The two main complications of transplant surgery are organ rejection and infection. Since the body recognizes the new lung as a foreign object, it will normally try to get rid of it or "reject" it. Anti-rejection drugs taken after surgery help prevent a rejection episode, but they also inhibit part of the immune system. Since the body's ability to fight infection is decreased, transplant recipients are more prone to infections.

Years of experience, research, and improved medicines help prevent rejection, and your transplant team will take every precaution to prevent these complications. While you are recovering in the hospital, you will learn to recognize signs of rejection and infection.

What are the warning signs of possible lung transplant rejection?

There are several symptoms that can be related to transplant rejection. If you are experiencing any of these symptoms, contact your transplant coordinator immediately. These symptoms can include:

  • Having a fever
  • Gaining weight
  • Experiencing flu-like symptoms (nausea, tiredness, body aches, diarrhea)
  • Feeling tender over the transplant site
  • Experiencing swelling

How is lung transplant rejection identified?

The transplant team will be able to determine if your body is rejecting your new lung by completing daily tests of pulmonary function during your hospital stay. If the team thinks you might be experiencing any problems with your new lung, the following tests might be completed:

  • Repeated blood work including a complete blood count.
  • Bronchoscopy with transbronchial biopsies.
  • A surveillance bronchoscopy is a procedure which is done to detect rejection of the lung at set intervals. These tests are performed routinely as part of your follow-up care (at three weeks, six weeks, three months, six months, nine months, and one year after transplant surgery) again to look for rejection.

How is lung transplant rejection treated?

If rejection develops, your doctor will prescribe medicine, usually steroids (either IV or by pills) to treat rejection and prevent further complications. In order to control the rejection, you might need to be admitted to the hospital or you might receive care in an outpatient setting, it will depend on several factors including the ability to administer IV medications at home by a home care nurse.

Will rejection treatment cause side effects?

To reduce troublesome side effects, your dosage might be decreased as soon as it is safe. In the meantime, htere are some daily practices that can hlep you prevent or decrease the side effects of prednisone. Eat well-balanced meals to aovid excess weight gain and to lower your risk of high blood pressure, diabetes, ulcers and bone and muscle problems, such as osteoporosis. In addition, decrease your salt intake.

Last reviewed by a Cleveland Clinic medical professional on 05/02/2018.


  • National Heart, Lung, and Blood Institute. What Is a Lung Transplant? (http://www.nhlbi.nih.gov/health/health-topics/topics/lungtxp/) Accessed May 2, 2018.
  • U.S. Department of Health and Human Services. Partnering With Your Transplant Team: The Patient’s Guide to Transplantation. (https://www.unos.org/wp-content/uploads/unos/PartneringWithTransplantTeam.pdf) Accessed May 2, 2018.

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