Acute Respiratory Distress Syndrome in Young Postrenal Transplant Patients Receiving Basiliximab

Renal transplants have been increasing in number due to the rise in end-stage renal disease (ESRD) worldwide. Transplant is a good approach to management of renal disease, as it offers patients a better quality of life. However, complications such as acute graft rejection remain a concern in all transplant patients. Basiliximab is an antibody commonly used as part of acute rejection prevention in renal transplantation. This antibody has been demonstrated to have comparable efficacy as other agents currently used, with the added benefit of decreasing the amount of steroids required for adequate immunosuppression. The general side effect profile for basiliximab includes infection, gastrointestinal disturbance, hypertension, and hyperkalemia. Respiratory system-related effects include dyspnea and upper respiratory tract infections, most of which have been documented to be mild or moderate in severity. However, a search of the literature reveals that there are a few reported cases of severe respiratory side effects in patients receiving basiliximab after renal transplants. In this report, we discuss two separate cases of acute respiratory distress syndrome (ARDS) that occurred in two young male patients. Both patients were without any other comorbidities, who had recently undergone renal transplantation and received basiliximab as part of acute rejection prevention. Both cases have a similar timeline of symptom onset, and both patients quickly developed severe respiratory failure requiring extracorporeal membrane oxygenation (ECMO) for respiratory support. Analysis of possible causes of respiratory failure points to a common medication that was administered to both patients. This report adds to a growing number of cases that suggest basiliximab may play a role in the development of respiratory failure in young patients undergoing renal transplantation surgery.