Urgent Lung Transplantation in Severe Acute Respiratory Failure Based on Rapidly Progressive Interstitial Lung Disease: A Case Report

Madurka, Ildikó; Elek, Jenö; Schönauer, Nóra; Bartók, Tibor; Kormosói-Tóth, Krisztina; Zöllei, Éva; Ghimessy, Áron; Láng, György; Klepetko, Walter; Rényi-Vámos, F

doi:10.1016/j.transproceed.2017.06.020

Cited by 4 publications

(2 citation statements)

References 16 publications

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“…Their institutional experience emphasizes the importance of single-organ failure, the ability to provide informed consent, and participation in physiotherapy as keys to success in transplantation for patients with ARDS. A similar case reported by Madurka et al concerned a 37-year-old female with ARDS due to a cryptogenic organizing pneumonia that underwent bilateral lung transplantation after approximately one month of V-V ECMO support (8). While the patient was initially weaned from ECMO and supplemental oxygen support following the operation and discharged home, she returned with worsening respiratory function and ultimately died 179 days after surgery.…”

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confidence: 53%

Urgent listing for lung transplant—a double-edged sword!

Gorton¹,

Keshavamurthy²

2023

Shanghai Chest

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Benedetto et al.(1) present a case of successful urgent lung transplantation in a patient with rapidly progressive interstitial lung disease (RPILD), specifically anti-MDA5 pulmonary scleroderma, which prompts many important questions about the approach to such patients. As the authors have noted, there has been a stigma around lung transplantation for patients with systemic sclerosis (SSc) due to perceived challenges both intraoperatively and in postoperative care. Overall transplantation rates for this group remains small with the International Society for Heart and Lung Transplantation (ISHLT) reporting connective tissue disease (CTD) accounting for 0.9% of all lung transplants in 2019, and SSc being a small portion of that number (2). Patients are at risk for many extrapulmonary manifestations of SSc, including cardiac, renal, gastrointestinal, and vascular pathologies, that should ideally be identified and formally evaluated prior to transplantation. These extrapulmonary manifestations may place the patient into absolute or relative contraindications to lung transplant per the ISHLT consensus document (2). However, recent evidence has demonstrated that short-and long-term survival in lung transplant for SSc are similar to patients with pulmonary fibrosis. Crespo et al. found 1-year survival of 81% for SSc vs. 79% for interstitial lung disease (ILD) and 5-year survival (conditional on 1-year survival) of 66% for SSc vs. 58% for ILD (3). This was supported by a similar result reported by Miele et al.showing 1-, 3-, and 5-year survival of 94%, 77%, and 70% in their SSc population which was not statistically different

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confidence: 53%

Urgent listing for lung transplant—a double-edged sword!

Gorton¹,

Keshavamurthy²

2023

Shanghai Chest

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“…Alemtuzumab has many uses both in haematology as well as other medical specialties. It has been used for a wide variety of conditions including multiple sclerosis,1 aplastic anaemia,2 chronic lymphocytic leukaemia,3 stem cell transplantation,4 lung transplantation,5 renal transplantation6 and vasculitis 7…”

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confidence: 99%

Development of acquired haemophilia A in a patient treated with alemtuzumab for multiple sclerosis

Madeley¹,

Hodges

Birchley

2018

BMJ Case Reports

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This case illustrates a 36-year-old man who presented with a factor VIII (FVIII) inhibitor (acquired haemophilia A) with cutaneous bleeding and a significant thigh haematoma. No traditional risk factors for the development of a FVIII inhibitor were identified. However, previous treatment with alemtuzumab for multiple sclerosis was noted in the patient’s history. Alemtuzumab is an anti-CD52 monoclonal antibody and is known to be associated with the development of a number of autoimmune conditions, with a delay in onset of these conditions as long as 5 years after the cessation of treatment. To our knowledge, there have only been three previously documented cases of a FVIII inhibitor in the setting of alemtuzumab therapy. This case adds further evidence to the current body of literature suggesting alemtuzumab as a causative agent for the development of an FVIII inhibitor.

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