Thymoglobulin anaphylaxis in an adult kidney transplant recipient managed with intraoperative ECMO

The use of intraoperative extracorporeal membrane oxygenation (ECMO) to stabilise a kidney transplant recipient with life-threatening thymoglobulin-induced anaphylaxis represents a novel approach to managing the associated perioperative complications. A man in his 40s with end-stage renal disease, type 1 diabetes and multiple comorbidities presented for a directed donor kidney transplant with no acute complaints aside from anuria. During thymoglobulin infusion, the patient developed hypoxia, hypotension, bronchospasm and reduced lung compliance, confirmed as anaphylaxis by elevated tryptase levels after ruling out infection, pulmonary embolism and myocardial infarction. Venovenous ECMO stabilised the patient's refractory hypoxia and haemodynamic collapse, allowing for successful transplantation the next day with an adjusted immunosuppressive course. This case report represents the first documented case of its kind, highlighting the need for early anaphylaxis recognition, the life-saving role of intraoperative ECMO and the importance of multidisciplinary readiness in transplantation.