title: Perioperative management of an IgA-deficient recipient of a double-lung transplant.
abstract: OBJECTIVE
  When exposed in the perioperative period to blood components containing immunoglobulin (Ig)A IgA-sensitized IgA-deficient patients are at an increased risk of transfusion-associated anaphylaxis. We present the case of an IgA-deficient patient whose candidacy for double-lung transplantation was under review in the preoperative period.
  
  
  METHODS
  A 49-yr-old patient with end-stage chronic obstructive lung disease secondary to deficiencies in IgA and IgG subclasses was being assessed for double-lung transplantation. Early recognition of the ramifications of perioperative transfusion prompted consultation with the transfusion medicine service. This in turn facilitated specialized laboratory testing and the coordinated provision of appropriate blood products for the unpredictable date of transplantation. The theoretical systemic risks of a non-IgA-deficient graft on the sensitized IgA-deficient host were considered. To affirm the patient's candidacy for transplantation, he was ultimately challenged preoperatively with IgA-containing products in a controlled intensive-care setting.
  
  
  CONCLUSIONS
  Through a multidisciplinary approach [corrected], a successful transplantation outcome was achieved in an IgA-deficient patient undergoing major surgery. Strategies to mitigate risk include the procurement and transfusion of IgA-deficient components, which may be challenging or untenable in emergent perioperative settings.
authors.affiliation: Department of Anesthesia, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada, asim.alam@sunnybrook.ca.
authors.forename: Asim
authors.initials: A
authors.lastname: Alam
authors.forename: Christine M
authors.initials: CM
authors.lastname: Cserti-Gazdewich
mesh_terms: D006801:Humans; D017098:IgA Deficiency / Q000150:complications*; D017099:IgG Deficiency / Q000150:complications; D007070:Immunoglobulin A / Q000008:administration & dosage; D033183:Interdisciplinary Communication; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D007070:Immunoglobulin A