Acute and Chronic Lung Allograft Rejection

Over the last decade, lung transplantation has become a 'viable option for patients with end-stage lung disease. Due to the relatively small number of lung transplants done nationally, little experience has been gained in the outcome and management of pregnancies in the post-lung transplant patient, and little published data exist to assist the patient's physician regarding issues related to pregnancy after lung transplantation. The vast majority of information on pregnancy after transplantation comes from renal allograft recipients,'14 including one review ofmore than 2,000 cases.5 Analysis of these pregnancies reveals a higher incidence of prematurity and low-birth-weight infants. Maternal effects include a substantial risk for the development of new hypertension, preeclampsia, or a permanent deterioration in renal graft function. There has been little evidence, however, for an increased incidence of acute rejection in these patients. Despite these complications, 92% of pregnancies that proceed beyond the first trimester end successfully. Much less experience has accumulated in pregnancies after liver or heart transplantation, although similar outcoimes have been observed in these patients. Although these aforementioned results suggest that pregnancy after solid organ transplantation is associated with reasonably good maternal and fetal outcomes, we describe a patient who underwent double lung transplantation and subsequently became pregnant with a course notable for severe obliterative bronchiolitis (OB). Our patient suffered a 50% irreversible decrement in FEV, immediately after her therapeutic abortion. This case illustrates a serious compli-