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Lung Transplantation

Are A1AT Injections Required After Lung Transplant?

03/08/2008

Question:

If someone has emphysema caused by an alpha-1 anti trypsin deficiency and they get a lung transplant will they need to continue getting the injections for their alpha-1 anti trypsin deficiency after the transplant?

Answer:

This is a question that has been debated amongst experts in lung transplantation and to date there is no clear consensus.  Since the alpha-1-antitrypsin (A1AT) protein is made in the liver, the recipient of a lung transplant still has the same deficiency of this protein as he/she did before the transplant.  Therefore, the transplanted lung is at the same risk of deterioration from A1AT deficiency as was the native lung.  Proponents of continuing A1AT replacement therapy use this fact to justify their continued use of this expensive treatment. 

Others point out that if the recipient of a lung transplant does not smoke cigarettes, then the deterioration of the transplanted lung is minimal and A1AT replacement therapy is not necessary. 

At this time whether or not a lung transplant recipient continues on A1AT replacement therapy is solely at the discretion of the patient and the lung transplant center.

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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