Successful Lung Retransplantation in a Patient With Acute Fibrinous and Organizing Pneumonia: A Case Report

Abstract Acute fibrinous and organizing pneumonia (AFOP) is an unusual histopathologic pattern characterized by the formation of intra-alveolar plugs of fibrin deposition and associated organizing pneumonia. AFOP is considered to be a form of rejection and portends a dismal prognosis. Here, we prese...

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Bibliographic Details
Published in:Transplantation proceedings 2015, Vol.47 (1), p.182-185
Main Authors: Renaud-Picard, B, Dégot, T, Biondini, D, Weingertner, N, Reeb, J, Chenard, M.P, Kessler, R
Format: Article
Language:English
Subjects:
Cystic Fibrosis - complications
Cystic Fibrosis - surgery
Graft Rejection - diagnosis
Graft Rejection - etiology
Graft Rejection - surgery
Humans
Lung Transplantation
Male
Opportunistic Infections - diagnosis
Opportunistic Infections - etiology
Opportunistic Infections - therapy
Pneumonia - diagnosis
Pneumonia - etiology
Pneumonia - surgery
Reoperation
Surgery
Tomography, X-Ray Computed
Young Adult
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Summary:Abstract Acute fibrinous and organizing pneumonia (AFOP) is an unusual histopathologic pattern characterized by the formation of intra-alveolar plugs of fibrin deposition and associated organizing pneumonia. AFOP is considered to be a form of rejection and portends a dismal prognosis. Here, we present the case of a young male patient who initially underwent a double lung transplantation for cystic fibrosis. After 42 months of regular follow-up, he experienced rapidly progressive respiratory failure. Acute rejection and opportunistic lung infections were suspected. The clinical conditions rapidly deteriorated despite treatment with broad-spectrum antibiotics and high-dose steroids. Therefore, AFOP was suspected owing to: 1) acute clinical presentation; 2) pulmonary computerized tomographic data; 3) typical histopathologic findings on transbronchial biopsieseconds, and 4) lack of response to different treatments. The patient required an emergency bilateral lung retransplantation 44 months after the initial transplantation. The histopathologic analysis of the explanted lungs confirmed the diagnosis of AFOP. Two years after the 2nd transplant, the patient is alive and well. To the best of our knowledge, this is the 1st case of a patient experiencing AFOP following lung transplantation who was successfully rescued by a 2nd bilateral lung retransplantation.
ISSN:0041-1345
1873-2623
DOI:10.1016/j.transproceed.2014.08.039