Service de Pneumologie et de Transplantation Pulmonaire, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université Denis Diderot, Paris France.
Vox Sang. 2013 Feb;104(2):175-8. doi: 10.1111/j.1423-0410.2012.01645.x. Epub 2012 Sep 18.
Three weeks after single-lung transplantation for pulmonary fibrosis, a patient with high serum levels of de novo donor-specific antibodies received high-dose intravenous immunoglobulin (IVIG) infusion (scheduled dose: 2 g/kg on 2 days) to prevent antibody-mediated rejection. Within the first hours after completion of infusions, he experienced acute lung injury involving the transplanted lung. Given the clinical evolution and the absence of an alternative diagnosis, transfusion-related acute lung injury (TRALI) was diagnosed. The IVIG administered on each day was from the same batch. At day 110, because of an increase in the serum titers of donor-specific antibodies, IVIG therapy was reintroduced but from a different batch, with excellent clinical tolerance. The lung injury was explored biologically, but no mechanism was revealed. Given the increasing use of IVIG in solid-organ recipients, clinicians should be aware of possible TRALI after IVIG infusion.
肺纤维化患者接受了单肺移植，3 周后，由于血清中存在高水平的新生供体特异性抗体，他接受了高剂量静脉注射免疫球蛋白（IVIG）输注（计划剂量：2 天内 2g/kg），以预防抗体介导的排斥反应。在输注完成后的最初几个小时内，他发生了急性肺损伤，累及移植肺。鉴于临床演变和缺乏其他诊断，诊断为输血相关的急性肺损伤（TRALI）。每天输注的 IVIG 来自同一批次。第 110 天，由于供体特异性抗体的血清滴度增加，重新引入了 IVIG 治疗，但来自不同批次，具有良好的临床耐受性。对肺损伤进行了生物学研究，但未发现任何机制。鉴于 IVIG 在实体器官受者中的使用越来越多，临床医生应意识到 IVIG 输注后可能会发生 TRALI。
