Korean J Transplant.  2020 Sep;34(3):193-198. 10.4285/kjt.2020.34.3.193.

Successful combined second redo lungkidney transplantation in a patient who developed end-stage renal disease after a previous lung transplantation

• Noh Jh
• Kim D
• Cho WH
• Yeo HJ

• KMID: 2507164
• DOI: http://doi.org/10.4285/kjt.2020.34.3.193

Abstract

Several lung transplantation (LTx) patients develop end-stage renal disease (ESRD) and often need a kidney transplant. Recently, the number of multiorgan transplantation cases has increased; however, no successfully combined redo lung-kidney transplantation has been reported in Korea. We present the first case of combined second redo lung-kidney transplantation in a patient with ESRD after LTx. In November 2018, a 40-year-old man with dyspnea was admitted to our hospital. Seventeen years ago, he underwent right pneumonectomy owing to refractory extensive drug-resistant tuberculosis. Four years ago, he underwent left single-LTx due to chronic respiratory failure. He was diagnosed with chronic lung allograft dysfunction and ESRD (glomerular filtration rate, <15). He underwent a second LTx that resulted in acute graft failure. Despite the empirical management, he was not responsive to treatment. He was required to use a home ventilator, but was able to maintain good muscle strength and to walk. However, regular dialysis was required. In January 2019, he underwent combined second redo lung-kidney transplantation and was discharged. At 1-year follow-up, his pulmonary and renal functions were stable without rejection. Combined lung-kidney transplantation could be an effective treatment for selective young patients with respiratory and renal failure who have undergone LTx.

Keyword

Lung transplantation; Kidney transplantation; Multiorgan transplantation

Figure

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  Fig. 1 (A) Chest radiograph showing right pneumonectomy and left lower lung field consolidation. (B) Pathology of the first lung transplantation tissue, showing pleuropulmonary fibrosis and intimal thickening of the large vessels, consistent with chronic lung allograft dysfunction. H&E, ×40.

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  Fig. 2 (A) Chest computed tomography image obtained on postoperative day 21 after redo lung transplantation showing increased multiple patchy areas of consolidation and ground-glass opacity on the left lower lung basal segment with a small amount of left pleural effusion, which may indicate interval aggravation of acute rejection. (B) Pathology of re-lung transplantation tissue showing organizing pneumonia, acute cellular rejection, diffuse alveolar damage, and fibrosis. H&E, ×100.

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