他克莫司、霉酚酸酯和血浆置换联合应用治疗肾移植术后急性体液性排斥反应

目的　探讨他克莫司 (FK5 0 6 )、霉酚酸酯和血浆置换联合应用治疗急性体液性排斥反应的效果。方法　 6例肾移植后发生急性体液性排斥反应的患者 ,术后采用环孢素A、霉酚酸酯和激素行免疫抑制治疗 ,发生急性体液性排斥反应时经甲泼尼龙和抗胸腺细胞球蛋白治疗无效 ,行血浆置换 4～ 6次 ,并给予FK5 0 6 (0 .2mg·kg-1·d-1)及霉酚酸酯 (由 2 g/d加至 3g/d)治疗。 结果　经 4～ 6次血浆置换和FK5 0 6、霉酚酸酯治疗 ,排斥反应得到逆转 ,6例患者肾功能均恢复良好 ,随诊 3～ 18个月 ,患者的血肌酐水平为 (12 5 .2± 2 6 .5 ) μmol/L。 结论　FK5 0 6、霉酚酸酯和血浆置换联合应用能有效地逆转急性体液性排斥反应     

心脏移植治疗终末期冠心病五例

目的总结心脏移植治疗终末期冠心病的体会。方法共有5例患者,1例为2次急性心肌梗死后行左心辅助泵植入术后25个月的患者,3例为急性心肌梗死后大面积无存活心肌、出现心力衰竭的患者,1例为经皮冠状动脉支架置入术和冠状动脉旁路移植术后仍反复发生心力衰竭的患者。均施行标准式原位心脏移植术。术前使用达利珠单抗诱导治疗1次,术后采用环孢素A、霉酚酸酯和泼尼松预防急性排斥反应。结果5例患者均痊愈出院,恢复正常的生活和工作,心功能均恢复至Ⅰ级;术后未发生严重的感染和急性排斥反应。结论心脏移植可作为治疗不适宜施行冠状动脉旁路移植术,或冠状动脉旁路移植术后效果较差的终末期冠心病患者的有效手段;选择合适的供心、良好的心肌保护、合理的抗排斥治疗方案,以及围手术期血压、血糖、血清胆固醇、尿酸的有效控制,是手术成功的关键。     

原位心脏移植治疗终末期心脏病141例

目的分析总结原位心脏移植治疗终末期心脏病的临床疗效及经验。方法为141例终末期心脏病患者施行原位心脏移植术,原发病包括扩张性性心肌病118例,肥厚性心肌病2例,限制性心肌病2例,缺血性心肌病9例,原发性心脏恶性肿瘤4例,瓣膜性心肌病3例,其它病因3例。供心冷缺血时间为(191.0±28.5)m in,供心卵圆孔未闭者9例,大室间隔缺损者1例,冠状动脉开口异常者1例。9例卵圆孔未闭的供心,先行卵圆孔缝闭术,然后再行移植;1例大室间隔缺损的供心,先行室间隔缺损修补术,然后再行移植;1例冠状动脉开口异常的供心,复跳后心肌收缩乏力,遂施行右冠状动脉松解术,其后复跳良好。120例行双腔静脉吻合法原位心脏移植术,19例行标准Stanford原位心脏移植术,2例行全心脏移植术。主动脉阻断时间为(53.0±4.5)m in,吻合时间为(41.5±5.5)m in。术后应用环孢素A(或他克莫司)、激素及霉酚酸酯预防排斥反应,28例患者同时应用达利珠单抗1~5剂。结果手术成功率为97.9%,术后随访1~65个月,1年、3年、5年存活率分别为90.8%、84.6%、81.4%,术后1年内的主要死因是急性排斥反应、感染、移植物功能衰竭及心脏肿瘤转移,术后中远期的主要死因是急性排斥反应、感染、肾功能衰竭及移植心脏冠状动脉硬化。术后并发症以急性排斥反应、感染、肾功能异常、移植心脏功能衰竭多见。结论终末期心脏病行原位心脏移植的临床疗效良好;远期需注意对急性排斥反应、感染及移植心脏冠状动脉硬化的监测及治疗。     

达利珠单抗联合环孢素A、霉酚酸酯及糖皮质激素预防肾移植后急性排斥反应

目的 观察达利珠单抗联合环孢素A、霉酚酸酯和糖皮质激素预防肾移植后急性排斥反应的有效性和安全性。方法 由15家肾移植中心参加的开放性临床试验，共纳入72例首次尸肾移植受者为研究对象，在接受环孢素A、霉酚酸酯和糖皮质激素联合应用预防肾移植后急性排斥反应的同时，给予2剂人源化达利珠单抗，首剂给予时间为术前24h内，第2剂在术后第14d给予。对入选患者密切随访，评价肾移植后3个月和6个月时急性排斥反应的发生率、严重程度以及人、肾存活率；评价该治疗方法的安全性。结果 术后3个月内有3例患者发生4次急性排斥反应，3个月及6个月的排斥反应发生率均为5．56％；人／肾6个月和1年的存活率分别为95.8％／95.8％和94．5％／94．5％；仅有1例的腹痛可能与达利珠单抗有关。结论 2剂达利珠单抗联合环孢素A、霉酚酸酯和糖皮质激素预防肾移植后的急性排斥反应安全有效。     

小肠移植术后排斥反应的诊断与治疗四例报告

目的 总结小肠移植术后排斥反应的诊断和治疗体会.方法 4例患者小肠移植术后均采用阿来佐单抗诱导及单用他克莫司(Tac)的无激素维持方案,术后前3个月血Tac浓度维持在10～15μg/L,术后4个月开始减少至5～10 μg/L,术后7个月开始减少至5/μg/L.术后采用临床症状观察、移植肠内镜观察及移植肠黏膜活检等方法监测排斥反应.排斥反应的诊断和分级则依据2003年国际小肠移植会议上确立的小肠移植急性排斥反应的病理学诊断标准.当发生IND级至轻度排斥反应时,提高血Tac浓度至15/μg/L并联合短程小剂量激素治疗,如排斥反应控制不理想,则应用大剂量激素冲击治疗;当发生中度排斥反应时,则提高血Tac浓度至15μg/L并联合大剂量激素冲击治疗.同时积极预防全身感染,停止肠内营养使肠道彻底休息.结果 4例患者术后共发生排斥反应9次,术后3个月内3例发生IND级至轻度排斥反应4次,术后3～6个月2例发生IND级至轻度排斥反应3次,术后7～12个月2例发生中度排斥反应2次.发生的9次排斥反应经治疗后均得到很好控制,移植肠功能恢复良好.IND级或轻度排斥反应的恢复时间为2～8d(平均4.8 d),中度排斥反应为15d.4例患者中有2例的存活时间已超过1年,1例为术后8个月余,1例为术后4个月,目前均在顺利康复中.结论 移植肠黏膜活组织病理学检查仍然是诊断排斥反应的金标准.提高血Tac浓度及联合应用激素治疗可成功逆转小肠移植排斥反应.     

肾移植术后急性体液性排斥反应的治疗

目的 总结肾移植术后急性体液性排斥反应中针对HLA抗体的检测和处理经验.方法 肾移植受者15例,术前行HLA分型、交叉配型和群体反应性抗体(PRA)的检测,术后采用他克莫司(或环孢素A)、霉酚酸酯和糖皮质激素预防排斥反应.15例于肾移植后1～14 d发生抗体介导的急性排斥反应(AMR),采用抗胸腺细胞球蛋白(100 mg/d,使用5 d)治疗,或将环孢素A转换为他克莫司,当PRA明显升高,且血清中出现供者特异性HLA抗体时,即行血浆置换(PP),共行1～5次,每次PP后静脉输注免疫球蛋白(IVIG)100～150 mg/kg,最后1次PP后给予WIG 200～500mg/kg.结果 术后出现抗供者特异性HLA Ⅰ类抗体者9例,抗HLAⅡ类抗体者4例,同时出现抗Ⅰ、Ⅱ类抗体者2例.14例的AMR逆转,1例术后发生移植肾功能恢复延迟,彩色多普勒超声波显示移植肾血流灌注差,于术后第10天切除移植肾.并行二行肾移植.2例AMR后并发急性肾小管坏死,透析后移植肾功能恢复正常.抗排斥反应治疗期间患者均未发生严重感染.随访12～52个月,1例因慢性移植肾肾病恢复血液透析治疗,1例死于心血管疾病,其余患者移植肾功能稳定.结论 将ATG、PP和IVIG联合应用能有效逆转AMR.     

他克莫司联合霉酚酸酯应用于胰肾联合移植的初步经验

目的 总结他克莫司(FK506)联合霉酚酸酯(MMF)应用于胰液膀胱引流式胰肾联合移植受者的初步经验. 方法 胰肾联合移植患者14例,术后应用FK506 0.07～0.15mg·kg-1·d-1加MMF 1.0～1.5 g/d加泼尼松25 mg/d三联免疫抑制治疗方案.采用微粒子酶免疫分析法每周测定口服FK506后全血峰谷浓度,依此调整剂量维持最初3个月内FK506全血浓度峰值10～20 μg/L,谷值5～15μg/L.并观察排斥反应的发生及药物的肝肾毒性. 结果 9例患者术后胰肾功能恢复良好,早期无排斥反应发生,血糖及肌酐水平恢复正常.随访18～70个月,平均34个月.存活1～3年者3例,3年～者1例,4年～者1例,>5年者4例,胰肾功能良好,血糖正常,均未使用降糖药.1例因超急性排斥反应术后第2天切除移植胰腺,随访2年肾功能良好.4例死亡,死因分别为术后急性右心功能衰竭、呼吸骤停、急性排斥反应及十二指肠瘘.胰肾联合移植术后各时期FK506全血峰、谷浓度差异均有统计学意义(P<0.05).术后共发生肾脏急性排斥反应4例次,肾毒性2例次,肝毒性1例次. 结论 FK506与MMF在药效上有协同作用,联合应用于胰肾联合移植具有良好的免疫抑制效果,能有效降低排斥反应发生率和提高移植物长期存活率.     

胰液膀胱引流式胰、肾联合移植二例报告

目的 总结膀胱引流术式胰、肾联合移植经验和教训。方法 对2例胰岛素依赖型糖尿病并发尿素症患者施行膀胱引流式胰、肾联合移植,术后早期采用皮质激素、霉酚酸酯（MMF）、环孢素A（CsA）／他克莫司（FK506）和抗淋巴细胞球蛋白（ALG）进行免疫抑制治疗,8－10d后改为FK506、MMFT和泼尼松维持。结果 移植后,2例均立即停用胰岛素,肾功能逐渐恢复正常, 仅例2术后并发轻微切口感染,经引流、局部处理后愈合,无基它外科并发症,未发生排斥反应,患者目前已分别存活6个月和2个月,移植胰和移植肾功能均正常,一般情况良好。结论 膀胱引流式胰、肾联合移植术后治疗胰岛素依赖糖尿病并发毒症的有效方法。     

应用霉酚酸酯联合小剂量环孢素A治疗肾移植术后慢性排斥反应

目的　探讨霉酚酸酯（MMF）联合小剂量环孢素A（CsA）和泼尼松（Pred)治疗肾移植术后慢性排斥反应的临床效果。方法　对临床诊断为慢性排斥反应的8例患者给予MMF1.5～2.0g/d、CsA2～3mg     

灵长类动物预致敏后肾移植加速排斥反应模型的建立

目的 建立灵长类动物预致敏后肾移植加速排斥反应模型.方法 取血型相容的正常猕猴配对,预先将供者腹部全层皮肤移植到受者背部,使受者预致敏.2周后再将同一供者的左侧肾脏移植到受者腹腔内,间时切除受者自体双肾,术后予以环孢素A、霉酚酸酯和泼尼松治疗(致敏用药组),不用免疫抑制剂者为对照(致敏对照组),以未致敏的肾移植作为对照组.术后观察受者血肌酐变化、移植物存活时间及病理特点.结果 对照组的4只移植肾存活时间分别为9、18、8、7 d;致敏对照组的3只移植肾存活时间分别为3、3、4 d;致敏用药组的3只移植肾存活时间分别为2、3、4 d.移植皮肤于术后10 d出现排斥反应,至术后14 d被完全排斥.对照组于肾移植1周以后才发牛排斥反应,而致敏者均在肾移植后3 d左右发生较严重的排斥反应.结论 受者被供者皮肤预致敏后再行肾移植,可以加速移植物的排斥,且不能被环孢素A、霉酚酸酯及泼尼松所组成的三联免疫抑制方案逆转.     

肝胰肾联合移植的免疫抑制治疗

目的 介绍1例存活超过1年的肝胰肾联合移植患者术后免疫抑制治疗方法。方法对1例肝炎后肝硬化合并尿毒症、I型糖尿病、慢性胰腺炎患者施行原位背驮式肝、胰液空肠引流式胰、十二指肠及肾一期联合移植，采用二剂巴利昔单抗（舒莱）诱导，抗胸腺细胞球蛋白（ATG）、他克莫司（FK506）、吗替麦考酚酯（MMF）、泼尼松四联维持治疗。结果 术后移植肝脏及胰腺功能1周内逐渐恢复；肾功能延迟恢复，于术后第16天因消化道大出血致肾脏血流下降，切除移植肾脏，于原移植部位进行第2次肾移植，术后第3天肾功能恢复正常，未发生排斥反应。患者已健康存活超过1年，移植肝、胰、肾功能良好，生活自理。结论 肝胰肾联合移植术前后采用二剂舒莱诱导，同时用ATG、FK506、MMF及泼尼松作为免疫维持治疗安全有效，用药期间进行移植物功能、血药浓度及T细胞亚群（CD4^＋，CD4^＋）监测是防治排斥反应、感染及药物中毒的有效手段。     

Mycophenolate mofetil (MMF) versus azathioprine (AZA) in pancreas transplantation: a single-center experience

AIM: Advances in immunosuppression and careful monitoring for rejection are largely responsible for improved results in pancreas transplantation. We conducted a retrospective study to establish the effectiveness of immunosuppressive therapy with mycophenolate mofetil (MMF) instead of azatioprine (AZA) in pancreas transplantation and to assess adverse effects in the two different immunosuppressive regimes. SUBJECTS AND METHODS: Since 1991, 27 pancreas transplantations were performed in 25 patients at our Institute. For induction therapy, immunosuppressant protocol consisted of quadruple immunosuppressive therapy with cyclosporine, steroids, antilymphocyte globulin and AZA in 13 patients or MMF in 12 patients respectively. RESULTS: Acute rejection occurred in 76% of patients in the AZA group compared with 53% in the MMF group. Steroid-resistant rejection was observed in 7% in the MMF group compared to 38% of patients on AZA (p < 0.01). Two kidney grafts were lost due to acute rejection in the AZA group, one pancreas was lost due to acute rejection and one to chronic rejection in the MMF group. There were no significant differences in CMV infection. Severe fungal infections were noted in 2 patients treated with MMF. Malignancy occurred in 1 patient (pancreas graft lymphoma) in MMF. CONCLUSIONS: In conclusion, patients treated with MMF required less frequent and less intensive treatment for acute rejection. However, its short- and long-term side effects should be further investigated.     

Late developing C4d-positive humoral renal allograft rejection associated with withdrawal of mycophenolate mofetil

In renal transplantation, C4d-positive acute humoral rejection (AHR) usually develops in the early stage posttransplantation. It is clear C4d can be detected late after the operation, when it is associated with chronic renal allograft rejection. We report a case of a renal allograft recipient who experienced C4d-positive acute renal allograft rejection associated with withdrawal of mycophenolate mofetil (MMF) at 10 months after transplantation. This 21-year-old single male patient received his first cadaveric renal allograft under immunosuppression with cyclosporine, MMF, and prednisolone. The serum creatinine recovered to the normal range within 4 days. A protocol biopsy performed at 1 month after transplantation revealed no signs of rejection. The graft function was stable until 10 months postoperation, when MMF was converted to mizoribin. Three days later a biopsy showed a C4d-positive rejection. Patient had no response to the MMF combined with tacrolimus and steroid bolus therapy, which generally improves 85% of AHR among Chinese. He finally returned to dialysis. Our report suggested that C4d positive AHR may occur late after transplantation. MMF is important to suppress the body's humoral response to allograft; when MMF was converted to a weaker immunosuppressant, the dose of the other immunosuppressants (cyclosporine for example) must be adjusted properly.     

个体化免疫抑制方案在心脏移植高危患者中的应用

目的 探讨个体化免疫抑制方案在心脏移植高危患者中的应用.方法 回顾分析2001年9月至2006年12月51例在围手术期合并HBV感染、糖尿病、肾功能不全或肺部感染的心脏移植病例,全组患者术前均采用达利珠单抗进行免疫诱导治疗,基础免疫抑制方案为环孢霉素A(CsA)、硫唑嘌呤(Aza)或吗替麦考酚酯(MMF)和泼尼松的三联方案.其中术前合并HBV感染10例,术后强调使用MMF,术后1个月停用泼尼松;术前合并糖尿病9例,术后并发移植后糖尿病4例,术后强调使用CsA,不用FK506,减量使用或停用泼尼松,配合胰岛素治疗;术前肾功能不全16例,术后常规使用MMF,术后第5～19天开始使用CsA;术后并发肺部感染12例,减量或暂停使用CsA、MMF和泼尼松.结果 术前合并HBV感染10例,随访1年肝功能稳定,1例于术后第13个月发生急性排斥反应.糖代谢异常13例,术后血糖控制满意,随访6个月无急性排斥反应发生.术前肾功能不全16例,随访1个月无急性排斥反应发生,肾功能恢复正常.术后并发肺部感染12例,2例死于严重的肺部感染,其他患者均存活;随访1个月,1例患者于术后第17天发生急性排斥反应.结论 免疫抑制方案的个体化能使心脏移植的高危患者平稳渡过围手术期,不会增加急性排斥反应的发生率.     

Randomised open clinical trial of conversion from mycophenolate mofetil to azathioprine in cadaveric renal transplantation

Abstract Mycophenolate mofetil (MMF) is a powerful immunosuppressive drug with established efficacy and safety. The search for a less expensive immunosuppressive protocol has led to an open randomised clinical trial of conversion from MMF to azathioprine (Aza). A total of 28 renal allograft recipients treated with prednisone, cyclosporine, and MMF was randomised into two groups: converted (early conversion) and control (late conversion). Conversion from MMF to Aza was conducted at the end of the 4th post‐transplant month in the converted group and after the 12th month in the control. During the 20‐month observation period, biopsy‐proven acute rejection occurred more frequently in the converted than in the control group, although the difference was not statistically significant. Early conversion from MMF to Aza increased the risk of subsequent rejection in those patients who underwent at least one episode of acute rejection prior to conversion.     

Tacrolimus versus cyclosporine after lung transplantation: a prospective, open, randomized two-center trial comparing two different immunosuppressive protocols.

BACKGROUND: The need for better immunosuppressive protocols after lung transplantation led us to investigate tacrolimus (Tac) in combination with mycophenolate mofetil (MMF) and steroids or cyclosporine (CsA) in combination with MMF and steroids in a prospective, open, randomized trial after lung transplantation. METHODS: Between September 1997 and April 1999, 50 lung transplant recipients were randomized to receive either Tac (n = 26) or CsA (n = 24) in combination with MMF and steroids. All patients underwent induction therapy with rabbit antithymocyte globulin (ATG) for 3 days. Freedom from acute rejection (AR), patient survival, infection episodes, and side effects were monitored. RESULTS: There was no difference in patient demographics between the two groups. Six-month and 1-year survival was similar (84.6% and 73.1% in the Tac group vs 83.3% and 79.2% in the CsA group). Freedom from AR at 6 months and 1 year after lung transplantation was slightly higher in the Tac group (57.7% and 50% vs 45.8% and 33.3%, p = not significant [n.s.]), whereas the number of treated rejection episodes per 100 patient days in the Tac group was significantly lower (0.225 vs 0.426, p < .05). Four patients in the CsA group had to be switched to Tac. Two patients in the CsA group had to be retransplanted. Incidence of infections was similar in both groups with a trend toward more fungal infections in the Tac group (n = 7 vs n = 1, p = n.s.). CONCLUSIONS: The combination of Tac and MMF seems to have slightly higher immunosuppressive potential compared with CsA and MMF. The effectiveness of Tac as a rescue agent is not paralleled with undue signs of overimmunosuppression.     

单肺移植同期行心内缺损修补术一例

目的探讨同种异体单肺移植同期行心内缺损修补治疗先天性心脏病室间隔缺损并艾森曼格综合征的可行性及围手术期的处理。方法2004年10月22日为1例先天性心脏病室间隔缺损合并艾森曼格综合征的患者在全麻低温体外循环下行右侧单肺移植，同期行室间隔缺损修补术。术中体外循环时间244min，供肺冷缺血时间6h。术后用他克莫司、霉酚酸酯和激素三联免疫抑制治疗。结果术后3d内移植肺出现中等度移植反应性肺水肿，术后7d气管切开，术后12d撤离呼吸机；术后14d出现急性排斥1次，治疗后缓解。术后肺动脉压力由术前的110／60mmHg降到53／39mmHg。术后30d胸片及胸部CT显示右侧移植肺清晰；肺通气／血流灌注扫描示右侧移植肺血流占90％；超声心动图检查示左心室内径较术前缩小17％，室间隔缺损修补完整，无残余分流；术后活动耐力明显改善，62d出院。结论对终末期左向右分流的先天性心脏病实施同种异体单肺移植的同期行心内畸形矫治是可行的。良好的供肺切取和保护以及完善的术后处理是成功的关键。     

Increased incidence of allograft rejection in stable heart transplant recipients after late conversion from mycophenolate mofetil to azathioprine.

Mycophenolate mofetil (MMF) is a safe and effective immunosuppressive agent in kidney and liver transplantation. Preliminary studies also support its use in heart transplantation. However, the cost of MMF is substantially greater than azathioprine (AZA), the current alternative. Since the majority of rejection episodes occur within the first few months of transplantation, using MMF early after transplantation and subsequently converting to AZA, after the risk of rejection has diminished, might be cost-effective. In order to evaluate the safety of such a strategy in heart transplant recipients, we reviewed the rejection profiles of a group of patients who were converted from MMF to AZA late after transplantation. Forty-three stable patients on chronic MMF therapy as part of an open-label, long-term safety study were converted to either commercially available MMF (CellCept) or AZA, at the conclusion of the study. Demographic variables, rejection histories before and after conversion, and immunosuppressive regimens were examined. Twenty-three patients were continued on commercial MMF and 20 were converted to AZA therapy. The average duration of MMF therapy prior to conversion was 41 months in each group. Baseline demographics were similar in the two groups. Treated allograft rejection occurred in 10 of 20 patients converting to AZA, as compared to only 1 of 23 patients remaining on MMF; p = 0.002. Additionally, mean scores (1-5 scale) for the three biopsies before and after conversion favored continued MMF therapy (1.5+/-0.6 before and 1.2+/-0.4 after conversion in MMF group vs. 1.3+/-0.5 before and 1.7+/-0.9 after conversion to AZA; p = 0.02). No allograft loss occurred as a result of conversion. These data suggest that conversion from MMF to AZA, even late after transplantation, can be associated with allograft rejection. The costs associated with these rejection episodes (the additional immunosuppressive agents, endomyocardial biopsies, and physician visits) may exceed the potential cost savings of converting stable heart transplant recipients from MMF to AZA.     

Mycophenolate mofetil added to immunosuppression after liver transplantation – first results

Mycophenolate mofetil (MMF) has been used successfully as an immunosuppressive agent after kidney and heart transplantation, but experience with MMF after liver transplantation is still limited. Between August 1995 and January 1996, we treated 20 patients with MMF after orthotopic liver transplantation in an open, prospective study. Five out of eight patients with acute rejection and one patient with early chronic rejection showed a complete response after MMF was added to the immunosuppression. Three patients with chronic rejection did not improve, one died, and two have stable graft function at present. In eight patients who suffered from toxicity, a reduction in the dosage of tacrolimus was attempted with simultaneous MMF therapy. One patient died due to multiple organ failure. Liver function improved completely in one other patient, and partially in three patients after adding MMF. In the remaining three patients, a reduced dosage of tacrolimus or cyclosporin, together with MMF, reduced toxicity, not significantly. In conclusion, MMF appears to be a safe and potentially useful adjuvant immunosuppressive agent for rescue and maintenance therapy. Received: 15 August 1996 Accepted: 6 December 1996     

Similarity of pulmonary rejection patterns among heart-lung and double-lung transplant recipients

The transbronchial biopsy and clinical courses of 9 double-lung and 1 single-lung recipients surviving greater than 10 days were analyzed and compared to those of 15 heart-lung transplants performed during the same time period. Of these, 8 isolated lung (LT) and 11 heart-lung transplant (HLT) recipients survived greater than 50 days and were at risk of developing obliterative bronchiolitis believed to be a form of chronic rejection. Cyclosporine-based immunosuppression, in combination with azathioprine and steroids, was used for 22 of 25 patients. Two double-lung recipients and 1 heart-lung patient received FK506 as the sole immunosuppressive agent; 90% and 62% of LT, and 67% and 54% of HLT recipients developed acute and chronic rejection, respectively (P = NS). The average time to first episode of acute (30.2 days [LT] versus 21.5 days [HLT]) and chronic rejection (146 days [LT] versus 193.7 days [HLT]) was not different between groups (P = NS). Age (34.2 [LT] versus 29.1 [HLT]) and sex (M:F, 5:5 [LT] versus 5:10 [HLT]) were also not found to be discriminators. The histologic diagnosis of chronic rejection was associated with significant declines in FEV1.0 and FEF25-75 (P less than 0.02). There was only one instance of cardiac rejection among the heart-lung transplant recipients. Heart-lung and isolated lung transplant patients appear to be at similar risk for developing acute or chronic pulmonary rejection.