title: Late-onset rejection of a unilateral donor lung with vascular C4d deposition in bilateral living-donor lobar lung transplantation: an autopsy case report.
abstract: A 37-year-old woman had undergone bilateral living-donor lobar lung transplantation 11 years previously for idiopathic pulmonary arterial hypertension. Her father donated the right lobe and her brother donated the left lobe. She subsequently developed progressively worsening respiratory dysfunction due to pneumonia. CT showed left dominant pulmonary artery dilatation, bronchial wall thickening and airway stenosis, followed by sudden death. An autopsy showed marked pathologic left dominant rejection of the pulmonary artery, small airway and large airway. Notably, only the left lung showed C4d vascular deposition, thus suggesting that antibody-mediated lung rejection may have occurred.
authors.affiliation: The First Department of Internal Medicine, Shinshu University School of Medicine, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yoshida
authors.forename: Tomonobu
authors.initials: T
authors.lastname: Koizumi
authors.forename: Yayoi
authors.initials: Y
authors.lastname: Tokoro
authors.forename: Toshiro
authors.initials: T
authors.lastname: Fukushima
authors.forename: Kazunari
authors.initials: K
authors.lastname: Tateishi
authors.forename: Atsuhito
authors.initials: A
authors.lastname: Ushiki
authors.forename: Toshiki
authors.initials: T
authors.lastname: Yokoyama
authors.forename: Masanori
authors.initials: M
authors.lastname: Yasuo
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Urushihata
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hanaoka
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Shingu
authors.forename: Hisashi
authors.initials: H
authors.lastname: Shimojo
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kanno
authors.forename: Akihiko
authors.initials: A
authors.lastname: Yoshizawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kawakami
authors.forename: Aya
authors.initials: A
authors.lastname: Miyagawa-Hayashino
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Date
authors.forename: Keishi
authors.initials: K
authors.lastname: Kubo
mesh_terms: D000328:Adult; D001344:Autopsy; D015704:CD4 Antigens / Q000276:immunology* / Q000378:metabolism; D017809:Fatal Outcome; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000473:pathology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000601:surgery; D019520:Living Donors; D016040:Lung Transplantation; D011651:Pulmonary Artery / Q000276:immunology / Q000378:metabolism / Q000473:pathology*; D013997:Time Factors
chemical_list: D015704:CD4 Antigens