Hyperacute Rejection in Single Lung Transplantation???case Report of Successful Management by Means of Plasmapheresis and Antithymocyte Globulin Treatment

Abstract

We describe the third case and first successful treatment of hyperacute rejection in a pulmonary allograft recipient and detail the immediate clinical findings. The patient underwent single right lung transplantation for severe emphysema and chronic obstructive pulmonary disease. Three hours after completion of the vascular anatomoses oxygen desaturation and increased airway pressure was noted in combination with graft edema, frothy, pink fluid draining from the bronchial orifice, hemodynamic instability, thrombocytopenia, and coagulopathy. The retrospective cross-match result was reported to be positive. The clinical diagnosis of hyperacute rejection was made. A donor-specific IgG HLA antibody to A2 was identified. The standard immune suppression regimen was immediately modified and a hyperacute rejection protocol applied including plasmapheresis and antithymocyte globulin treatment as well as cyclophosphamide to decrease antibody existence and production. A remarkable clinical recovery was observed after the fifth postoperative day and completion of plasmapheresis when a repeated retrospective cross-match showed significantly decreasing anti-donor reactivity.

Antibody-Mediated Rejection in Lung Transplantation: Clinical Outcomes and Donor-Specific Antibody Characteristics

“…This is reminiscent of results reported by Witt et al (16) and suggests different underlying pathophysiologies. Nevertheless, a previous report of hyperacute AMR linked to preformed HLA-A2 DSAs (37) and the occurrence of AMR with solely preformed or class I (n ¼ 1) DSAs in our study are evidence that warrants consideration of these two characteristics during AMR diagnosis. Interestingly, all AMR patients had DQ DSA except the sole patient without DQ mismatch; however, because DQ DSAs were also frequently found in the DSA pos AMR neg population, this characteristic is not significantly associated with CLAD occurrence or graft survival.…”

Aprotinin decreases reperfusion injury and allograft dysfunction in clinical lung transplantation☆

“…Thirty patients were excluded from the data analysis because of clinical incomparability such as lung re-transplantation (n = 7), heart-lung transplantation (n = 8), lung transplantation for primary pulmonary hypertension (n = 7), lung transplantation for Eisenmenger's syndrome (n = 6), and living-lobar transplantation (n = 1). One more patient was excluded due to the diagnosis of hyperacute rejection and significant HLA-mismatch [3]. This patient was managed with a complex immunosuppressive regimen deviating significantly from the standard protocol.…”

Antibody-Mediated Rejection in Cardiac Transplantation: Emerging Knowledge in Diagnosis and Management

“…152 Although there have been successful cases in which AMR has been treated successfully with ATG in combination with other immunosuppressive therapy, this class of drugs requires testing as part of a randomized trial in AMR. 108,143,[153][154][155][156] …”