Li Ping-Chun, Thorat Ashok, Hsu Shih-Chao, Poon Kin-Shing, Yang Horng-Ren, Chen Te-Hung, Yeh Chun-Chieh, Jeng Long-Bin
Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.
Department of Cardiovascular Surgery, China Medical University Hospital, Taichung, Taiwan.
Ann Transplant. 2017 Jul 28;22:463-467. doi: 10.12659/aot.903788.
BACKGROUND Rituximab is commonly used to reduce the agglutinin titer in ABO-incompatible liver transplant recipients. Although well-tolerated, rituximab infusion therapy may result in severe pulmonary adverse effects such as drug-induced pneumonitis, leading to acute respiratory distress syndrome (ARDS), which has a high mortality rate. Management of such rare cases in an ABO-incompatible patient has never been described before. Herein, we present successful use of extracorporeal membrane oxygenation (ECMO) support for rituximab-induced ARDS in an ABO-incompatible living donor liver transplantation (LDLT) recipient. CASE REPORT A 57-year-old man patient presented with acute-on-chronic hepatic failure. Due to worsening clinical condition and unavailability of a deceased donor organ, ABO-incompatible LDLT was considered. The patient received rituximab therapy and plasmapheresis 1 week before the transplantation to reduce the B cell count. However, he suddenly developed acute respiratory distress-like symptoms, with a chest X-ray suggesting organized pneumonia. Infectious etiology was excluded as evidenced from negative sputum and blood culture, which were repeated after 48 h. LDLT was performed and ECMO support was instituted in the immediate postoperative period due to worsening of the ARDS. The pulmonary signs improved, with a chest X-ray showing clear lung fields on the 5th postoperative day. The patient recovered well and was discharged with normal liver functions in the 4th postoperative month. CONCLUSIONS This is first reported experience of successful use of ECMO in an ABO-incompatible liver transplant recipient with rituximab-induced ARDS. This experience shows the feasibility and effectiveness of ECMO support in liver transplant recipients with poor respiratory functions.
背景 利妥昔单抗常用于降低ABO血型不相容肝移植受者的凝集素滴度。尽管利妥昔单抗输注疗法耐受性良好，但可能导致严重的肺部不良反应，如药物性肺炎，进而引发急性呼吸窘迫综合征（ARDS），其死亡率很高。此前从未有过在ABO血型不相容患者中处理此类罕见病例的报道。在此，我们报告了在一名ABO血型不相容的活体供肝肝移植（LDLT）受者中成功使用体外膜肺氧合（ECMO）支持治疗利妥昔单抗诱导的ARDS的病例。病例报告 一名57岁男性患者出现慢性肝功能衰竭急性发作。由于临床状况恶化且无法获得脑死亡供体器官，考虑进行ABO血型不相容的LDLT。患者在移植前1周接受了利妥昔单抗治疗和血浆置换以降低B细胞计数。然而，他突然出现急性呼吸窘迫样症状，胸部X线显示为机化性肺炎。痰和血培养均为阴性，48小时后复查仍为阴性，排除了感染性病因。进行了LDLT，术后因ARDS恶化立即给予ECMO支持。肺部体征改善，术后第5天胸部X线显示肺野清晰。患者恢复良好，术后第4个月肝功能正常出院。结论 这是首次报道在ABO血型不相容的肝移植受者中成功使用ECMO治疗利妥昔单抗诱导的ARDS的经验。这一经验表明ECMO支持在呼吸功能较差的肝移植受者中的可行性和有效性。
