Korean J Transplant.  2023 Nov;37(Suppl 1):S303. 10.4285/ATW2023.F-9125.

Desensitization of a highly sensitized lung transplant recipient immediately after childbirth with a history of multiple births: a case report

• Lee HA
• Haam S
• Park JW
• Jung YJ
• Chung WY
• Sheen SS
• Jung J
• Yu W
• Park JE

• KMID: 2551932
• DOI: http://doi.org/10.4285/ATW2023.F-9125

Abstract

Sensitization to human leukocyte antigen (HLA) is a significant obstacle to successful lung transplantation. If irreversible diffuse lung damage occurs due to acute respiratory distress syndrome (ARDS) caused by acute infection, there are many limitations to having the opportunity for lung transplantation. We report a case in which a lung transplant was successfully performed on a highly sensitized patient with coronavirus disease 2019 (COVID-19) infection during the peripartum period. A 39-year-old woman was admitted with severe ARDS caused by COVID-19 infection. Based on the patient’s medical records, she had no diagnosed diseases. However, it is noteworthy that the patient had given birth three times and delivered her fourth child 2 days before admission. Despite receiving invasive mechanical ventilation, her oxygenation rapidly deteriorated. Venous-venous extracorporeal membrane oxygenation (ECMO) was initiated on the 7th day of hospitalization. The patient’s condition continued to worsen, and on the 28 day of hospitalization, chest computed tomography (CT) confirmed irreversible changes marked by numerous air cysts, which necessitated lung transplantation. Before lung transplant, the patient exhibited high levels of mean fluorescence intensity (MFI) in anti-human leukocyte antigen (HLA) testing (Class I: MFI 25,738, calculated panel-reactive antibody [cPRA] 100%; Class II: MFI 1,581, cPRA 0%), likely due to multiparity. A bilateral lung transplant was performed on the 72nd day of ECMO application, using a desensitization protocol involving perioperative plasma exchange without basiliximab induction, followed by five plasma exchange sessions. Intravenous immunoglobulin was not administered due to pneumonia recurrence while waiting for a transplant. ECMO was successfully discontinued immediately after the lung transplant. The patient was discharged on the 108th day (postoperative day 29) with no hypoxia in room air and could return to normal daily activities after 3 months.