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https://hdl.handle.net/2440/79797
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Type: | Journal article |
Title: | Lessons and insights from ABO-incompatible lung transplantation |
Author: | Snell, G. Holmes, M. Levvey, B. Shipp, A. Robertson, C. Westall, G. Cohney, S. |
Citation: | American Journal of Transplantation, 2013; 13(5):1350-1353 |
Publisher: | Blackwell Munksgaard |
Issue Date: | 2013 |
ISSN: | 1600-6135 1600-6143 |
Statement of Responsibility: | G. I. Snell, M. Holmes, B. J. Levvey, A. Shipp, C. Robertson, G. P. Westall and S. Cohney |
Abstract: | With ABO blood group incompatibility (ABOi) between donor and recipient becoming a part of mainstream living-donor renal transplantation, the applicability of ABOi to other areas of transplantation is being reconsidered. Here we present a case of inadvertent ABOi lung retransplantation managed successfully with initial plasmapheresis, antithymocyte globulin and intravenous immunoglobulin; and subsequently with oral cyclophosphamide and sirolimus in addition to tacrolimus and prednisolone. Interestingly, in the setting of solid levels of tacrolimus and sirolimus, the patient developed a fatal thrombotic microangiopathy of uncertain origin subsequent to the cessation of cyclophosphamide at 9 years posttransplant. It is apparent that ABOi lung transplantation can result in surprisingly successful long-term outcomes. Low pretransplant antibody titers likely aid this and, in pediatric neonatal or infant cases, this may not be uncommon. We must proceed cautiously as there are significant risks. Understanding the monitoring, prevention and treatment of lung transplant antibody-mediated rejection, while avoiding the long-term complications of overimmunosuppression, will be the keys to the success of future cases. |
Keywords: | ABO-incompatibility hemolytic uremic syndrome lung transplantation thrombotic microangiopathy |
Rights: | © Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons |
DOI: | 10.1111/ajt.12185 |
Published version: | http://dx.doi.org/10.1111/ajt.12185 |
Appears in Collections: | Aurora harvest 4 Medicine publications |
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