Table 3.

Arguments for and against maintaining augmentation therapy after lung transplant.

In Favor	Against
The biochemical efficacy is expected to be the same as in non-transplanted AATD patients.	There are no formal trials on its clinical efficacy in lung density deterioration after transplant.
Augmentation therapy is safe and well-tolerated, and patients get used to it as part of their lives. It is not expected to create an additional burden.	Lung transplant patients already have to cope with a considerable amount of medication with potential adverse effects that determine their lives, without adding another treatment of unproven efficacy in this context.
AATD lung-transplant patients are generally younger, with a longer life expectancy, so it is vital to take all the necessary measures to protect the transplanted lung.	Emphysema due to AATD is a slow, progressive disease. It may take decades until clinically relevant emphysema is developed in the new lung.
The number of lung donors is limited, so every transplant has an opportunity cost, since it could have been received by another patient. Therefore, it is unethical not to take all possible steps to preserve the transplanted lung.	It has not been proven that the risk of rejection is increased if recipients do not receive augmentation therapy.