PRETELL: PREvention of TELomere-related Complications After Lung Transplant

Inclusion Criteria: 1. Age greater than 18 2. Ability to give informed consent 3. Recipient of lung transplantation 4. Short telomeres assessed either pre-transplant or post-transplant with FLOW-FISH as lymphocyte telomere length \<10th percentile predicted for age 5. Clinically stable one month after lung transplant Exclusion Criteria: 1. Patients on androgen hormones to include testosterone or high dose estrogen (estradiol 0.5 mg/day or greater) during 12 months prior to enrollment 2. Patients with active thrombosis or thromboembolic disease and history of such events unless thrombosis is line related. 3. Undiagnosed abnormal genital bleeding, porphyria, androgen-dependent tumor, or prostatic hypertrophy 4. Patients with active hepatitis B or C 5. Patients who have received a bone marrow transplant 6. Clinically unstable after lung transplantation 7. Current pregnancy, or unwillingness to take be on two forms of contraceptives including a barrier method of birth control or practice abstinence to refrain from pregnancy if of childbearing potential during the course of the study 8. Lactating women, due to the potentially harmful effects on the nursing child 9. Patients with abnormal liver function AST, ALT \>3 times normal 10. Subjects with a history of benign intracranial hypertension 11. Subjects with a history of liver disease not limited to alcoholic hepatitis/cirrhosis, non-alcoholic steatohepatitis (NASH), autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), and/or history of hepatic adenoma. 12. Subjects with poorly controlled or uncontrolled Type I or II diabetes mellitus 13. Significant renal abnormalities GFR\< 40 ml/min/m2 14. Significant cardiac dysfunction with ejection fraction less than 50% 15. Moribund status such as death is expected in the coming year 16. Currently taking carbamazepine, pimozide or lomitapide 17. Inability to understand the investigational nature of the study or to give informed consent