Eculizumab as rescue therapy for antibody-mediated rejection in a high-risk lung transplant recipient: A case report

To describe the management of refractory antibody-mediated rejection (AMR) in a highly sensitized lung transplant recipient, emphasizing the use of eculizumab as rescue therapy, and to highlight the importance of continuous monitoring in posttransplant patients and the role of multidisciplinary teams in addressing complex cases of graft rejection.

This case report describes a 58-year-old woman with high immunologic risk who underwent bilateral lung transplantation. The patient did not receive pretransplant desensitization. In the early posttransplant period, she developed possible AMR with severe respiratory deterioration and required venovenous extracorporeal membrane oxygenation (ECMO). Initial treatment included corticosteroids, plasmapheresis, intravenous immune globulins, and thymoglobulin. However, donor-specific antibodies levels increased, and the patient's respiratory condition deteriorated further. Eculizumab was administered as second-line therapy, leading to both clinical and immunological improvement. The patient survived and was eventually discharged from the intensive care unit.

Eculizumab may represent a viable rescue option in cases of refractory AMR after lung transplantation, including in patients requiring ECMO support. This case highlights the importance of tailored therapeutic strategies and multidisciplinary evaluation in managing high-risk transplant recipients.