Antibody-mediated rejection in lung transplantation: case reports.
We present two cases of lung-transplanted patients who exhibited: (1) donor-specific anti-HLA antibodies at multiple times after transplantation; (2) continuous, linear, and sub-endothelial C4d deposition concomitantly with detection of anti-HLA antibodies; and (3) biopsy-proven rejections that were refractory to augmented anti-T-cell therapy. In both patients, the pulmonary function progressively diminished, ultimately ending with allograft failure. One patient received a second lung transplant, which allowed us to detect additional donor-specific antibodies directed towards the previous allograft (sponge effect). The presence of donor-specific anti-HLA antibodies in the context of vascular C4d deposition and refractory acute rejection fulfills the criteria for antibody-mediated rejection in these two lung-transplanted patients.
Girnita
Alin L
AL
University of Pittsburgh Medical Center, USA.
McCurry
Kenneth R
KR
Yousem
Samuel A
SA
Pilewski
Joseph
J
Zeevi
Adriana
A
D000328:Adult; D004646:Emphysema / Q000601:surgery; D005260:Female; D006084:Graft Rejection / Q000276:immunology*; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D007518:Isoantibodies / Q000276:immunology*; D016040:Lung Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D019896:alpha 1-Antitrypsin Deficiency / Q000601:surgery
D006680:HLA Antigens; D007518:Isoantibodies