Treatment of Intractable Interstitial Lung Injury with Alemtuzumab after Lung Transplantation

Abstract A 44-year-old woman underwent left single-lung transplantation for end-stage emphysema due to α1-antitrypsin deficiency in January 2010. Cyclosporine, azathioprine, and prednisolone were administered for immunosuppression and antithymocyte globulin for induction therapy at the time of trans...

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Bibliographic Details
Published in:Transplantation proceedings 2011-06, Vol.43 (5), p.1868-1870
Main Authors: Kohno, M, Perch, M, Andersen, E, Carlsen, J, Andersen, C.B, Iversen, M
Format: Article
Language:English
Subjects:
Adult
Alemtuzumab
Antibodies, Monoclonal - administration & dosage
Antibodies, Monoclonal - therapeutic use
Antibodies, Monoclonal, Humanized
Antibodies, Neoplasm - administration & dosage
Antibodies, Neoplasm - therapeutic use
Biological and medical sciences
Female
Fundamental and applied biological sciences. Psychology
Fundamental immunology
Humans
Injections, Intravenous
Lung Diseases, Interstitial - drug therapy
Lung Transplantation - adverse effects
Medical sciences
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Tissue, organ and graft immunology
Treatment Outcome
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Summary:Abstract A 44-year-old woman underwent left single-lung transplantation for end-stage emphysema due to α1-antitrypsin deficiency in January 2010. Cyclosporine, azathioprine, and prednisolone were administered for immunosuppression and antithymocyte globulin for induction therapy at the time of transplantation. Routine examination of a lung biopsy, 4 months after transplantation, showed nonspecific, diffuse interstitial inflammation with alveolar septal fibrosis. The patient's clinical status and imaging studies, consistent with nonspecific interstitial pneumonitis, which was considered as signs of acute rejection, worsened within 2 weeks, despite high-dose steroids, change of calcineurin inhibitor, and plasmapheresis. Within a few days after a single, 10-mg, intravenous dose of alemtuzumab, the patient's health improved markedly. She has remained stable for 4 months on a standard, ambulatory, posttransplant antirejection drug regimen. We have since successfully treated with alemtuzumab three additional patients who developed interstitial lung injury after lung transplantation, who are also summarized in this report.
ISSN:0041-1345
1873-2623
DOI:10.1016/j.transproceed.2011.02.007