Lessons and insights from ABO-incompatible lung transplantation

Area of Science:

• Immunology
• Transplantation Medicine
• Nephrology

Background:

• ABO blood group incompatibility (ABOi) is increasingly accepted in renal transplantation.
• This case explores ABOi in lung retransplantation, a less common application.
• Successful management strategies for ABOi solid organ transplantation are evolving.

Observation:

• An inadvertent ABOi lung retransplantation case is presented.
• Initial treatment involved plasmapheresis, antithymocyte globulin, and IV immunoglobulin.
• Subsequent immunosuppression included oral cyclophosphamide, sirolimus, tacrolimus, and prednisolone.

Findings:

• The patient achieved successful long-term outcomes post-ABOi lung retransplantation.
• Low pretransplant antibody titers may contribute to favorable outcomes.
• A fatal thrombotic microangiopathy occurred 9 years post-transplant after cyclophosphamide cessation.

Implications:

• ABOi lung transplantation is feasible but carries significant risks.
• Careful monitoring for antibody-mediated rejection and immunosuppression complications is crucial.
• Future success depends on understanding and managing rejection and long-term side effects.