Successful management of an ABO-mismatched lung allograft using antigen-specific immunoadsorption, complement inhibition, and immunomodulatory therapy.
BACKGROUND
Successful management of an ABO-mismatched lung allograft recipient has not previously been described.


METHODS
Because of a clerical error, a 67-year-old blood type B patient with idiopathic pulmonary fibrosis received a left single-lung allograft from a blood type A donor. Cyclophosphamide was added to immunosuppression with anti-thymocyte globulin induction, cyclosporine, mycophenolate mofetil, and prednisone. When increasing anti-A antibody titers were detected, antigen-specific immunoadsorption, anti-CD20 monoclonal antibody, and recombinant soluble complement receptor type 1 (TP10) were administered.


RESULTS
Rising anti-A antibody titers were reduced acutely by immunoadsorption, and remained low during long-term follow-up. Humoral injury to the graft was not detected. Acute cellular rejection and multiple complications were successfully managed. Three years after transplantation the patient is clinically well on stable maintenance immunosuppression and prophylactic photochemotherapy.


CONCLUSIONS
Modulation of anti-A antibody, preserved graft function, and a favorable patient outcome can be achieved for an ABO-mismatched lung allograft.
Department of Cardiothoracic Surgery, Vanderbilt University Medical Center and Nashville VAMC, Tennessee 37232-5734, USA. robin.pierson@mcmail.vanderbilt.edu
Richard N
RN
Pierson
James E
JE
Loyd
Andrea
A
Goodwin
Dan
D
Majors
J Stephen
JS
Dummer
Paul
P
Mohacsi
Alistair
A
Wheeler
Nicolai
N
Bovin
Geraldine G
GG
Miller
Sandy
S
Olson
Joyce
J
Johnson
Robert
R
Rieben
Agnes
A
Azimzadeh
D000017:ABO Blood-Group System; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D000961:Antilymphocyte Serum / Q000008:administration & dosage; D001787:Blood Group Incompatibility / Q000276:immunology / Q000628:therapy*; D003165:Complement System Proteins / Q000276:immunology*; D003520:Cyclophosphamide / Q000008:administration & dosage; D016572:Cyclosporine / Q000008:administration & dosage; D006085:Graft Survival / Q000276:immunology; D006801:Humans; D007163:Immunosorbent Techniques; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D016040:Lung Transplantation / Q000276:immunology*; D008297:Male; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D011241:Prednisone / Q000008:administration & dosage; D014184:Transplantation, Homologous
D000017:ABO Blood-Group System; D000893:Anti-Inflammatory Agents; D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003520:Cyclophosphamide; D003165:Complement System Proteins; D009173:Mycophenolic Acid; D011241:Prednisone