Lung transplantation in an 18-month-old with donor specific antibodies – The use of intraoperative,targeted plasma exchange

Abstract

Background:

Sensitised patients undergoing Human Leukocyte Antigen-incompatible transplantation are at increased risk of hyperacute rejection and may be predisposed to antibody-mediated rejection, chronic lung allograft dysfunction and higher mortality.

Case:

We present a case of primary lung transplantation in the setting of late identification of donor specific antibodies treated with intraoperative target plasma exchange. The patient was treated with fresh human plasma to a final volume of 1.5 times the patient’s systemic circulation. From a pre-transplant mean fluorescence intensity of 5002, donor-specific antibodies were undetectable following plasma exchange on single antigen bead assay.

Conclusions:

This method represents a potential desensitisation technique for use in the intraoperative period.