title: Pulmonary capillaritis as a manifestation of acute humoral allograft rejection following infant lung transplantation.
abstract: Pulmonary capillaritis has been described in adult lung transplant recipients, but has not been previously reported in pediatric recipients. We report a case of posttransplant pulmonary capillaritis in an 8-month-old infant, and demonstrate evidence of C4d deposition and B-lymphocytes in the allograft, donor anti-HLA antibodies in the serum and a clinical and immunohistochemical response to anti-CD20 monoclonal antibody (rituximab) therapy. These findings strongly support the hypothesis that pulmonary capillaritis may represent a form of acute humoral rejection in the lung allograft that is less common than, and clinically and histologically distinct from, typical acute cellular rejection.
authors.affiliation: Division of Pulmonary Medicine, Nationwide, Children's Hospital, Columbus, OH, USA. todd.astor@nationwidechildrens.org
authors.forename: T L
authors.initials: TL
authors.lastname: Astor
authors.forename: M
authors.initials: M
authors.lastname: Galantowicz
authors.forename: A
authors.initials: A
authors.lastname: Phillips
authors.forename: J
authors.initials: J
authors.lastname: Palafox
authors.forename: P
authors.initials: P
authors.lastname: Baker
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20 / Q000378:metabolism; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002196:Capillaries / Q000473:pathology*; D006084:Graft Rejection / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007223:Infant; D008168:Lung / Q000098:blood supply; D008171:Lung Diseases / Q000628:therapy; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D011183:Postoperative Complications; D000069283:Rituximab; D014657:Vasculitis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D000970:Antineoplastic Agents; D000069283:Rituximab