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Lung Transplantation

Alpha-1 antitrypsin and lung transplant

06/13/2009

Question:

If an individual has alpha-1 antitrypsin deficiency and gets a lung transplant, do they still take the weekly injections of alpha-1 proteinase inhibitor?

Answer:

Among lung transplant experts there is no clear consensus regarding the need for continuation of alpha-1-proteinase inhibitor infusions following lung transplantation.

While in the body there remains an excess of proteinases with respect to proteinase inhibitors following transplantation and thus a theoretical benefit to continuing such proteinase inhibitor infusions, there is no compelling evidence that the transplanted lung suffers injury from not continuing these infusions.

What is likely more important than the continued infusion of proteinase inhibitor is the abstinence of cigarette smoking, which clearly "tips the balance" in favor of the injurious proteinases. Because of this lack of consensus, some lung transplant programs have recommended continuation of the proteinase inhibitor infusions while other programs have not.

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Response by:

David  R Nunley, MD, FCCP David R Nunley, MD, FCCP
Former Associate Professor
College of Medicine
The Ohio State University