학술논문
Management of an ABO-incompatible lung transplant.
Document Type
Academic Journal
Author
Banner NR; Transplant Unit, Harefield Hospital, Royal Brompton and Harefield NHS Trust, Harefield, Middlesex, UK.; Rose ML; Cummins D; de Silva M; Pottle A; Lyster H; Doyle P; Carby M; Khaghani A
Source
Publisher: Elsevier Country of Publication: United States NLM ID: 100968638 Publication Model: Print Cited Medium: Print ISSN: 1600-6135 (Print) Linking ISSN: 16006135 NLM ISO Abbreviation: Am J Transplant Subsets: MEDLINE
Subject
Language
English
ISSN
1600-6135
Abstract
A 24-year-old woman with cystic fibrosis underwent bilateral sequential lung transplantation and unintentionally received an ABO incompatible graft (blood type A(1) graft into a type O recipient). The recipient had a high titer of IgG anti-A antibody (256 by the indirect antiglobulin test). Emergency treatment included antibody removal by plasmapheresis and additional immunosuppression with mycophenolate, rabbit antithymocyte globulin and polyspecific intravenous immunoglobulin. Subsequently, immunoadsorption and the anti-CD20 antibody rituximab were used to remove anti-A antibody and inhibit its resynthesis. Early graft function was good; one episode of rejection at Day 46 responded promptly to treatment with methylprednisolone. Subsequently, graft function continued to improve and anti-A antibody titers remained low. No infectious or other complications were encountered. The treatment regimen that we adopted may prove useful in other cases of unplanned ABO-incompatible organ transplants. The successful outcome suggests that planned ABO-incompatible lung transplants may be possible.