Late-onset Rejection of a Unilateral Donor Lung with Vascular C4d Deposition in Bilateral Living-donor Lobar Lung Transplantation: An Autopsy Case Report

Hiroshi Yamamoto; Kazuo Yoshida; Tomonobu Koizumi; Yayoi Tokoro; Toshiro Fukushima; Kazunari Tateishi; Atsuhito Ushiki; Toshiki Yokoyama; Masanori Yasuo; Kazuhisa Urushihata; Masayuki Hanaoka; Kunihiko Shingu; Hisashi Shimojo; Hiroyuki Kanno; Akihiko Yoshizawa; Satoshi Kawakami; Aya Miyagawa-Hayashino; Hiroshi Date; Keishi Kubo

doi:10.2169/internalmedicine.53.2583

CASE REPORTS

Late-onset Rejection of a Unilateral Donor Lung with Vascular C4d Deposition in Bilateral Living-donor Lobar Lung Transplantation: An Autopsy Case Report

Hiroshi Yamamoto, Kazuo Yoshida, Tomonobu Koizumi, Yayoi Tokoro, Toshiro Fukushima, Kazunari Tateishi, Atsuhito Ushiki, Toshiki Yokoyama, Masanori Yasuo, Kazuhisa Urushihata, Masayuki Hanaoka, Kunihiko Shingu, Hisashi Shimojo, Hiroyuki Kanno, Akihiko Yoshizawa, Satoshi Kawakami, Aya Miyagawa-Hayashino, Hiroshi Date, Keishi Kubo

Author information

Hiroshi Yamamoto
The First Department of Internal Medicine, Shinshu University School of Medicine, Japan
Kazuo Yoshida
Department of Thoracic Surgery, Shinshu University School of Medicine, Japan
Tomonobu Koizumi
The First Department of Internal Medicine, Shinshu University School of Medicine, Japan
Yayoi Tokoro
The First Department of Internal Medicine, Shinshu University School of Medicine, Japan
Toshiro Fukushima
The First Department of Internal Medicine, Shinshu University School of Medicine, Japan
Kazunari Tateishi
The First Department of Internal Medicine, Shinshu University School of Medicine, Japan
Atsuhito Ushiki
The First Department of Internal Medicine, Shinshu University School of Medicine, Japan
Toshiki Yokoyama
The First Department of Internal Medicine, Shinshu University School of Medicine, Japan
Masanori Yasuo
The First Department of Internal Medicine, Shinshu University School of Medicine, Japan
Kazuhisa Urushihata
The First Department of Internal Medicine, Shinshu University School of Medicine, Japan
Masayuki Hanaoka
The First Department of Internal Medicine, Shinshu University School of Medicine, Japan
Kunihiko Shingu
Department of Pathology, Shinshu University School of Medicine, Japan
Hisashi Shimojo
Department of Pathology, Shinshu University School of Medicine, Japan
Hiroyuki Kanno
Department of Pathology, Shinshu University School of Medicine, Japan
Akihiko Yoshizawa
Department of Laboratory Medicine, Shinshu University School of Medicine, Japan
Satoshi Kawakami
Department of Radiology, Shinshu University School of Medicine, Japan
Aya Miyagawa-Hayashino
Department of Diagnostic Pathology, Kyoto University Hospital, Japan
Hiroshi Date
Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Japan
Keishi Kubo
The First Department of Internal Medicine, Shinshu University School of Medicine, Japan

Keywords: idiopathic pulmonary arterial hypertension (IPAH), living-donor lobar lung transplantation (LDLLT), C4d, antibody-mediated lung rejection (AMR)

JOURNAL OPEN ACCESS

2014 Volume 53 Issue 15 Pages 1645-1650

DOI https://doi.org/10.2169/internalmedicine.53.2583

Details

Abstract

A 37-year-old woman had undergone bilateral living-donor lobar lung transplantation 11 years previously for idiopathic pulmonary arterial hypertension. Her father donated the right lobe and her brother donated the left lobe. She subsequently developed progressively worsening respiratory dysfunction due to pneumonia. CT showed left dominant pulmonary artery dilatation, bronchial wall thickening and airway stenosis, followed by sudden death. An autopsy showed marked pathologic left dominant rejection of the pulmonary artery, small airway and large airway. Notably, only the left lung showed C4d vascular deposition, thus suggesting that antibody-mediated lung rejection may have occurred.

Corresponding author

Register with J-STAGE for free!