Vanderbilt University Medical Center
Lung Transplant Program
Bronchoscopy (FOB) & Acute Rejection Protocol
Revised 01/05/09
Surveillance Bronchoscopy Protocol:
Day 7:
1 week
Bronchoalveolar lavage (BAL)
Day 30:
1 month
BAL
Transbronchial biopsy (TBBx) (preferred 10 biopsy
specimens from two different lobes of transplanted
lung)
Day 90:
3 month
BAL & TBBx
Day 180:
6 months
BAL & TBBx
Day 365:
1 year
BAL & TBBx
Episodically for decreased FEV1, increased SOB, decreased SaO2.
This schedule may be modified if patients have intermittent bronchoscopy for
1) changes in spirometry OR
2) infectious symptoms/signs.
ACUTE REJECTION PROTOCOL
(SURVEILLANCE & NON SURVEILLANCE):
Revised 01/05/09
Based on TBBx:
Grade A2 or higher: -1 gram methylprednisolone IV q24hrs X 3 doses OR
100 mg prednisone Taper – attending MD to decide
- If treatment is within the first 180 days post transplant,
repeat IV Gancyclovir
Grade A1 or lower: Oral steroid taper (100 mg), continue surveillance
If A2 or higher: 4-6 week follow up bronch to ensure clearance and check serum
CMV PCR quantification and formal spirometry. If FOB negative then patient will
resume surveillance (see above). If A2 acute rejection persists, patient will
receive additional pulse IV steroids - 1 gram methylprednisolone IV qd X 3 days
followed by oral taper (starting at 60 mg) and consider switching Cellcept (from
Imuran.
If A2 persists consider antibody therapy (Thymoglobulin).
** There is physician consultation for any deviation from the protocol.
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