3 Key Takeaways
Plain English Summary- 01Core Finding
The donor was positive for cytomegalovirus and positive for Epstein-Barr virus, and the recipient was negative for cytomegalovirus and positive for Epstein-Barr virus.
- 02Study Evidence
Study design used a clinical case insight protocol to track clinical outcomes.
- 03Practical Meaning
Benefits and risks vary by individual health history — discuss with a healthcare professional.
What This Means for You
Antibody-mediated rejection was successfully treated with our institutional multimodal regimen, including a combination of plasmapheresis, carfilzomib, and anti-thymocyte globulin followed by monthly IV immunoglobulin and tocilizumab injections. Also, because of calcineurin inhibitor (CNI)-related renal dysfunction, the patient's immunosuppression was converted to a belatacept-based CNI-sparing regimen in addition to prednisone, with a tacrolimus goal trough of 4 to 6 ng/mL. He was also placed on mycophenolic acid, which was soon held because of neutropenia.
The Discovery
A 64-year-old man who underwent bilateral orthotopic lung transplant for emphysema related to α1-antitrypsin deficiency 8 months ago presented to the clinic for assessment of bilateral pulmonary nodules identified on routine postlung transplant surveillance without any symptomatic concerns. The donor was positive for cytomegalovirus and positive for Epstein-Barr virus, and the recipient was negative for cytomegalovirus and positive for Epstein-Barr virus. He denied any fever, chills, cough, chest pain, dyspnea, weight loss, or night sweats. The patient lived in South Florida with no recent travel history outside the United States or infectious contacts. His posttransplant course was complicated with antibody-mediated rejection at 1.5 months after lung transplant.
How It Works, Simply
This pulmonology research focuses on antibodies · Immune response. Researchers evaluated it using a standard-of-care clinical practice · Clinical case insight at the clinical practice stage of medical research.
3 Key Takeaways
Clinical Takeaways- 01Core Finding
The donor was positive for cytomegalovirus and positive for Epstein-Barr virus, and the recipient was negative for cytomegalovirus and positive for Epstein-Barr virus.
- 02Study Evidence
Study design used a clinical case insight protocol to track clinical outcomes.
- 03Practical Meaning
Benefits and risks vary by individual health history — discuss with a healthcare professional.
Biological Mechanism & Study Design
Study Design & Cohort
Clinical case insight
Standard-of-care clinical practice · Clinical case insight · Clinical Practice
Biological Pathway & Modality
Antibodies · Immune response
Intervention: Bilateral Pulmonary Nodules After Lung Transplantation: A Rare Diagnosis
Experimental Findings & Endpoints
A 64-year-old man who underwent bilateral orthotopic lung transplant for emphysema related to α1-antitrypsin deficiency 8 months ago presented to the clinic for assessment of bilateral pulmonary nodules identified on routine postlung transplant surveillance without any symptomatic concerns.
The donor was positive for cytomegalovirus and positive for Epstein-Barr virus, and the recipient was negative for cytomegalovirus and positive for Epstein-Barr virus. He denied any fever, chills, cough, chest pain, dyspnea, weight loss, or night sweats.
The patient lived in South Florida with no recent travel history outside the United States or infectious contacts. His posttransplant course was complicated with antibody-mediated rejection at 1.5 months after lung transplant.
Clinical Translation & Practice Context
Antibody-mediated rejection was successfully treated with our institutional multimodal regimen, including a combination of plasmapheresis, carfilzomib, and anti-thymocyte globulin followed by monthly IV immunoglobulin and tocilizumab injections.
Also, because of calcineurin inhibitor (CNI)-related renal dysfunction, the patient's immunosuppression was converted to a belatacept-based CNI-sparing regimen in addition to prednisone, with a tacrolimus goal trough of 4 to 6 ng/mL. He was also placed on mycophenolic acid, which was soon held because of neutropenia.
The Bottom Line · Clinical Pearl
“He was also placed on mycophenolic acid, which was soon held because of neutropenia.”
Published in Chest · Current Stage: Clinical Practice