Hyperacute Rejection After Single Lung Transplantation: A Case Report

• Published in: Transplantation proceedings Vol. 40; no. 3; pp. 867 - 869
• Main Authors: de Jesus Peixoto Camargo, J, Marcantonio Camargo, S, Marcelo Schio, S, Noguchi Machuca, T, Adélia Perin, F
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01-04-2008; Elsevier Science
• Subjects: Acute Disease; Biological and medical sciences; Fatal Outcome; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Graft Rejection - pathology; Humans; Lung Transplantation - pathology; Medical sciences; Middle Aged; Obesity - complications; Pulmonary Disease, Chronic Obstructive - surgery; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue, organ and graft immunology; Transplantation, Homologous; Case study; Human; Medicine; Rejection; Treatment; Surgery; Lung; Graft; Transplantation; Homotransplantation; Respiratory system; Hyperacute
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2008.02.052

Abstract Hyperacute rejection is a well-known complication in kidney and heart transplantations. However, its occurrence in lung transplantation is extremely rare, with only 4 cases previously described. A 53-year-old female patient blood type O with end-stage chronic obstructive pulmonary disease underwent left lung transplantation. She had 2 negative pretransplantation evaluations for panel-reactive antibodies. One hour after the vascular clamps were released, progressive hypoxia developed. Fiberoptic bronchoscopy revealed an optimal bronchial anastomosis; an abundant pink frothy fluid was observed on the allograft side. Chest X ray sevealed a completely opacified left lung. Due to the low-compliance of the transplanted lung and the risk for native lung hyperinsufflation, independent mechanical ventilation was employed. Despite all measures, multiple organ failure developed and the patient died 24 hours after the procedure. A necropsy evaluation for confirmed the patency of all anastomoses and no signs of ischemia. Retrospectively, a new evaluation for panel-reactive antibodies was performed, with 24% reactivity. Complement-dependent cytotoxicity crossmatch was negative, however, a flow cytometric analysis was positive for both HLA-I (56%) and HLA-II (45%). Further investigation detected an anti-A2 in the recipient serum and the donor had an A2 antigen. Hyperacute rejection is a rare posttransplantation complication highlighted by its precocity and lethality. With the increased number of lung transplantations performed yearly, it is believed that its incidence will also rise. Therefore, prompt diagnosis and familiarity with management strategies are fundamental.