title: Lessons and insights from ABO-incompatible lung transplantation.
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.
authors: Department of Allergy, Immunology and Respiratory Medicine, Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, Australia. g.snell@alfred.org.au
authors: G I
authors: GI
authors: Snell
authors: M
authors: M
authors: Holmes
authors: B J
authors: BJ
authors: Levvey
authors: A
authors: A
authors: Shipp
authors: C
authors: C
authors: Robertson
authors: G P
authors: GP
authors: Westall
authors: S
authors: S
authors: Cohney
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000293:Adolescent; D001787:Blood Group Incompatibility / Q000150:complications* / Q000276:immunology; D017809:Fatal Outcome; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology* / Q000276:immunology; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects* / Q000276:immunology; D008297:Male
chemical_list: D000017:ABO Blood-Group System