Treatment of severe acute lung allograft rejection with OKT3 and temporary extracorporeal membrane oxygenation bridging.
OBJECTIVE
The use of OKT3 for treatment of advanced high-grade acute rejection episodes eventually can result in cytokine release and consecutive pulmonary edema. Temporary extracorporeal membrane oxygenation (ECMO) bridging can be used to overcome this crucial period before the beneficial effects of OKT3 can be observed.


METHODS
We summarize our experience with three patients, who underwent lung transplantation and presented with severe acute rejection episodes. OKT3 had to be initiated due to insufficient response to standard rejection therapy with corticosteroids. Upon initiation of OKT3 treatment, a massive life-threatening deterioration of lung function in spite of heavily invasive respirator treatment was seen and temporary ECMO support was imperative to support graft function. Results of this treatment were retrospectively reviewed.


RESULTS
In all cases femoro-femoral veno-arterial ECMO was used for support of the impaired graft and after a period of 4-5 days led to a massive improvement of graft function. In the further course two patients could be discharged from hospital and are still alive 30 and 36 months, respectively, after the described incident. One patient died 4 months later due to liver failure.


CONCLUSIONS
We conclude that the use of ECMO support in patients experiencing significant side effects from OKT3 therapy is a useful and effective therapeutic tool to overcome the initial critical period until the lung has sufficiently recovered.
Aigner
Clemens
C
Department of Cardiothoracic Surgery, University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
Jaksch
Peter
P
Mazhar
Samy
S
Czebe
Kriztina
K
Marta
Gabriel
G
Taghavi
Sharokh
S
Lang
Georg
G
Klepetko
Walter
W
D000208:Acute Disease; D000328:Adult; D003131:Combined Modality Therapy; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006084:Graft Rejection / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D016853:Muromonab-CD3 / Q000627:therapeutic use*; D011859:Radiography
D007166:Immunosuppressive Agents; D016853:Muromonab-CD3