A 25-year old man underwent bilateral lung transplantation for
end-stage cystic fibrosis. His donor was a 50-year-old man, an
ex-smoker with a 10-pack-year history who had abstained for 20 years
prior to suffering a catastrophic subarachnoid hemorrhage. The
recipient’s posttransplant progress was straightforward, although a
Pseudomonas empyema required drainage and IV antibiotics.
Immunosuppression was conventional, with cyclosporine, azathioprine,
and steroids following a 3-day course of induction antithymocyte
globulin, as is routine at our center. Results of a CT scan of
his chest performed at 4 months in order to investigate retrosternal
pain were unremarkable. Surveillance bronchoscopy and transbronchial
biopsy were carried out at 1 week, 3 months, 6 months, and 9 months.
There was never any evidence of rejection on these biopsies
(International Society for Heart-Lung Transplantation grade A1 or
less), and no other endobronchial or histologic abnormalities were