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Two Case Reports of Successful Withdrawal of Mycofenolate Mofetil After Living Donor Lobar Lung Transplantation


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Title: Two Case Reports of Successful Withdrawal of Mycofenolate Mofetil After Living Donor Lobar Lung Transplantation
Authors: Miyazaki, Takuro / Tagawa, Tsutomu / Yamasaki, Naoya / Tsuchiya, Tomoshi / Matsumoto, Keitaro / Nagayasu, Takeshi
Issue Date: Jan-2013
Publisher: Elsevier
Citation: Transplantation Proceedings, 45(1), pp.356-359; 2013
Abstract: Background: Lung transplantation cases have immunosuppression maintained using a calcineurin inhibitor, anti-metabolites, and steroid. Case Report: We report 2 clinical cases in which anti-metabolites (mycophenolate mofetil) were successfully withdrawn after living donor lobar lung transplantation by monitoring immune function using the ImmuKnow® assay. In the first case, a 43-year-old woman underwent living donor lobar lung transplantation for pulmonary alveolar proteinosis. Two healthy relatives donated a lower lobe each. Immunosuppression was maintained using tacrolimus, mycophenolate mofetil, and steroid. Six months posttransplantation, she developed invasive pulmonary aspergillosis. During anti-fungal treatment, we withdrew mycophenolate mofetil and tacrolimus trough levels were kept around 8 ng/mL. Despite the resulting low-level immunosuppression, the ImmuKnow assay showed immune function to be in the moderate range with tacrolimus and steroid alone, encouraging us to maintain this strategy to avoid recurrence of invasive pulmonary aspergillosis. In the second case, a 24-year-old man underwent living donor lobar lung transplantation for cystic fibrosis. Two healthy relatives donated a lower lobe each. Immunosuppression was maintained using tacrolimus, mycophenolate mofetil, and steroid. Five months posttransplantation, he developed persistent Pseudomonas aeruginosa pneumonia derived from the paranasal sinuses. Under ImmuKnow assay monitoring, mycophenolate mofetil was withdrawn, but immune function was maintained within the moderate range using tacrolimus and steroid alone. Discussion: Respiratory function in both cases was maintained; no findings of bronchiolitis obliterans syndrome were noted during this period. To the best of our knowledge, no reports have described successful anti-metabolite withdrawal in lung transplantation with ImmuKnow monitoring. Immune evaluation by ImmuKnow could offer a useful method to monitor and control immune status, particularly among recipients susceptible to infection, revealing that moderate immune function could be maintained using tacrolimus and steroid in living donor lobar lung transplantation.
Keywords: amphotericin B / cotrimoxazole / itraconazole / micafungin / mycophenolic acid 2 morpholinoethyl ester / prednisolone / tacrolimus / voriconazole / adult / antimicrobial therapy / article / case report / drug withdrawal / female / human / immune function test / immunoassay / immunosuppressive treatment / living donor lobar lung transplantation / lung aspergillosis / lung transplantation / male / medical history / patient monitoring / postoperative infection / priority journal / T lymphocyte
URI: http://hdl.handle.net/10069/31486
ISSN: 00411345
DOI: 10.1016/j.transproceed.2012.09.112
Rights: © 2013 Elsevier Inc. / NOTICE: this is the author’s version of a work that was accepted for publication in Transplantation Proceedings. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Transplantation Proceedings, 45, 1(2013)
Type: Journal Article
Text Version: author
Appears in Collections:Articles in academic journal

Citable URI : http://hdl.handle.net/10069/31486

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