Lessons and insights from ABO-incompatible lung transplantation

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dc.contributor.authorSnell, G.
dc.contributor.authorHolmes, M.
dc.contributor.authorLevvey, B.
dc.contributor.authorShipp, A.
dc.contributor.authorRobertson, C.
dc.contributor.authorWestall, G.
dc.contributor.authorCohney, S.
dc.date.issued2013
dc.description.abstractWith 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.
dc.description.statementofresponsibilityG. I. Snell, M. Holmes, B. J. Levvey, A. Shipp, C. Robertson, G. P. Westall and S. Cohney
dc.identifier.citationAmerican Journal of Transplantation, 2013; 13(5):1350-1353
dc.identifier.doi10.1111/ajt.12185
dc.identifier.issn1600-6135
dc.identifier.issn1600-6143
dc.identifier.urihttp://hdl.handle.net/2440/79797
dc.language.isoen
dc.publisherBlackwell Munksgaard
dc.rights© Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons
dc.source.urihttps://doi.org/10.1111/ajt.12185
dc.subjectABO-incompatibility
dc.subjecthemolytic uremic syndrome
dc.subjectlung transplantation
dc.subjectthrombotic microangiopathy
dc.titleLessons and insights from ABO-incompatible lung transplantation
dc.typeJournal article
pubs.publication-statusPublished

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