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Title: Lessons and insights from ABO incompatible lung transplantation.
Epworth Authors: Cohney, Solomon (Shlomo)
Other Authors: Snell, Greg
Holmes, M.
Levvey, Bronwyn
Shipp, A.
Robertson, C.
Westall, G. P.
Keywords: ABO Blood-Group System
Blood Group Incompatibility
Blood Group Incompatibility
Fatal Outcome
Graft Rejection
Lung Transplantation
ABO Blood-Group System
Antithymocyte globulin
Intravenous Immunoglobulin
Oral Cyclophosphamide
Fatal Thrombotic Microangiopathy
Pretransplant Antibody Titers
UroRenal, Vascular Clinical Institute, Epworth HealthCare, Victoria, Australia
Department of Gastroenterology, Epworth HealthCare, Victoria, Australia
Issue Date: May-2013
Publisher: Wiley Online
Citation: Am J Transplant. 2013 May;13(5):1350-3.
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.
DOI: 10.1111/ajt.12185
PubMed URL:
ISSN: 1600-6143
Journal Title: American Journal of Transplantation
Type: Journal Article
Affiliated Organisations: Department of Allergy, Immunology and Respiratory Medicine, Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, Australia.
Type of Clinical Study or Trial: Case Reports
Appears in Collections:UroRenal, Vascular

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