Ventilation-perfusion inequalities in a patient with obliterative bronchiolitis after single-lung transplantation for primary pulmonary hypertension.

The assessment ofgraft rejection after single-lung transplantation (SLT) is often difficult. Therefore, it was with great interest that we read the article by Levine et al,’ which appeared in the February 1992 issue of Chest. The authors described their experience with ventilation-perfusion (V/Q) inequalities during graft rejection after SLT for primary pulmonary hypertension (PPH). We recently had a similar experience. A 49-year-old white woman with a history of PPH underwent right SLT in June 1991. Immunosuppression therapy consisted of cyclosporine, azathioprine, and corticosteroids. During the first 2 months after transplantation she was given four courses of methylprednisolone for rejection suspected on clinical grounds. Patient and donor were both seropositive for cyto)megalovirus (CMV). Fomr weeks after transplantation, CMV reactivation was o)bserved; the vinis was isolated from bronchoalveolar lavage fluid and pleural fluid. Transbronchial biopsies showed some infiltration of plasma cells in the submucosa o)f the walls of the bronchioles, but there were no signs o)f acute vascular rejection, bacterial infection, or CMV infection. The patient was treated by lowering the dosage o)f azathioprine, and subsequently anti-CMV immunoglobulin C was seen to he increased. She made a full clinical recovery from this