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Case Reports
. 2019 Jul 31;25(2):10.7196/AJTCCM.2019.v25i2.010.
doi: 10.7196/AJTCCM.2019.v25i2.010. eCollection 2019.

Acute cellular rejection in lung transplantation

F Manyeruke  1 , T Pennel  2 , R Roberts  3 , G L Calligaro  1
Affiliations
Case Reports

Acute cellular rejection in lung transplantation

F Manyeruke et al. Afr J Thorac Crit Care Med. .

Abstract

Lung transplantation is an important therapy for end-stage respiratory failure in patients who have exhausted other therapeutic options. The lung is unique among solid-organ transplants in that it is exposed to the outside environment, and undergoes continuous stimulation from infectious and non-infectious agents, which may play a part in upregulating the immune response to the allograft. Despite induction immunosuppression and the use of aggressive maintenance regimens, acute allograft rejection is still a major problem, especially in the first year after transplant, with important diagnostic and therapeutic challenges. As well as being responsible for early graft failure and death, acute rejection also initiates alloimmune responses that predispose patients to chronic lung allograft dysfunction, in particular bronchiolitis obliterans syndrome. Cellular responses to human leukocyte antigens (HLAs) on the allograft have traditionally been considered the main mechanism of acute rejection, although the influence of humoral immunity is increasingly recognised. Here, we present two cases of acute cellular rejection (ACR) in the early post-transplant period and review the pathophysiology, diagnosis, clinical presentation and treatment of ACR.

Keywords: cellular rejection; lung transplantation.

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Conflict of interest statement

Conflicts of interest: None.

Figures

Fig. 1
Fig. 1
High-resolution computed tomography scan of the chest. (A) Pre-treatment scan showing extensive, bilateral ground-glass opacities (GGO) and (B) in the resolution phase, after treatment with corticosteroids, showing improvement in the GGO globally but with persistence of some centrilobular ground-glass nodules in the right lung posteriorly.
Fig. 2
Fig. 2
Transbronchial lung biopsies (haematoxylin and eosin staining). (A) Well-expanded airspaces with discrete perivascular cellular infiltrates, grade A2 (40×). (B) Multiple layers of lymphocytes surrounding a pulmonary venule, grade A2 (200×). (C) Sub-endothelial lymphocytes expanding an alveolar septum and associated endothelialitis grade A3. (D) A bronchiole with scanty submucosal lymphocytes showing grade B1R rejection (400×).
Fig. 3
Fig. 3
Classification of AMR. AMR = antibody-mediated rejection DSA = donor-specfic antibodies C4d = complement 4d
See this image and copyright information in PMC

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