Intraoperative Versus Postoperative Thymoglobulin in Lung Transplantation

The purpose of this study is to take a population of lung transplant recipients who meet UCLA
criteria for induction chemotherapy with thymoglobulin and prospectively study weather giving
the first dose intraoperatively versus postoperatively makes a difference with how patients
do during and after lung transplantation. In addition, these cohorts will be compared to
patients who do not qualify for thymoglobulin and receive either an alternative agent or no
agent. The primary endpoint is primary graft dysfunction. We will also evaluate several other
early and late end points such as ventilator days, ICU/hospital days, acute/chronic
rejection, infection, CT chest abnormalities, and survival.

We will also collect donor lung tissue and lavage fluid for measurement of various proteins
and receptor expression at two time points: (1) prior to implementation and dosing of
induction chemotherapy and (2) after transplantation (following a course of induction
chemotherapy). This will allow us to possibly make a connection between the profiles of the
various proteins and receptors and the clinical outcomes, depending on weather the patient
has received induction chemotherapy, starting intraoperatively or postoperatively.

Inclusion Criteria:

- On a voluntary basis, all patients eligible for bilateral lung transplantation between
the ages of 18-65 years (inclusive)

Exclusion Criteria:

- Have any known allergy to horse or rabbit antithymocyte polyclonal agents

- Have a preoperative platelet count less then 100,000/mm3

- Are recipients of multiple organ transplants (either simultaneous or sequential)

- Are recipients of a single lung transplantation

- Have a contraindication to rabbit antithymocyte globulin based on judgement of the
investigators (i.e. bleeding diathesis or overwhelming risk of intense
immunosuppression) including the following patients: greater than 65 years of age,
prior diagnosis of malignancy (with the exception skin malignancies), underlying
suppurative lung disease (i.e. bronchiectasis, cystic fibrosis, etc.).