2 research outputs found
Lung Retransplantation with Positive Crossmatch in Primary Lung Transplantation Complicated by Antibody-Mediated Rejection
La hipertensi贸n arterial pulmonar (HAP) representa el 2,6% de los trasplantes pulmonares (TP), con una mediana de supervivencia condicional(desde los 30 d铆as del TP) de 9,8 a帽os. Son frecuentes, el rechazo celular agudo (ACR) y la disfunci贸n cr贸nica del injerto (CLAD),mientras que es infrecuente el rechazo mediado por anticuerpos (AMR). El retrasplante pulmonar (RTP) constituye el 4% del TP mundial,debido a complicaciones en la v铆a a茅rea, disfunci贸n primaria del injerto, ACR y CLAD. Mujer de 22 a帽os, portadora de HAP idiop谩tica(HAPI) desde el a帽o 2013, trasplantada bipulmonar (TBP) en enero de 2018. A los 16 meses present贸 neumon铆a adquirida en la comunidad.En una internaci贸n posterior, present贸 ACR y a pesar de pulsos de metilprednisolona, progres贸 a requerimientos de c谩nula de altoflujo y ventilaci贸n mec谩nica no invasiva hospitalaria, ca铆da del VEF1, y tomograf铆a de t贸rax con vidrio esmerilado difuso y engrosamientoirregular reticular del intersticio subpleural; interpret谩ndose como CLAD a predominio de s铆ndrome de bronquiolitis obliterante (BOS),con presencia de anticuerpos espec铆ficos contra el donante (DSA). En enero de 2020 se realiz贸 nuevo TP y ante cross-match positivo, serealiz贸 plasmaf茅resis y reposici贸n de IgG. Al mes del egreso, no se observaron signos de rechazo en control de biopsias transbronquiales.Entre 2 y 10% de los pacientes con indicaci贸n primaria de TP por HAPI son sometidos a retrasplante pulmonar (RTP). La presencia deDSA y el miss-match de HLA, no son contraindicaciones para el RTP.Pulmonary arterial hypertension (PAH) represents 2.6% of lung transplantations (LT), with a conditional median survival (from 30 days after LT) of 9.8 years. Acute cellular rejection (ACR) and chronic lung allograft dysfunction (CLAD) are common; whereas the antibody-mediated rejection (AMR) is not. Lung retransplantation (LR) accounts for 4% of global LTs for complications in the airways, primary allograft dysfunction, ACR and CLAD. 22-year-old woman with idiopathic PAH (IPAH) since 2013, who underwent a double-lung transplantation (DLT) in January 2018. 16 months after transplantation she presented community-acquired pneumonia. During a subsequent hospitalization, she presented ACR. Despite the fact that she received pulse methylprednisolone, she required high-flow cannula therapy and hospital non-invasive mechanical ventilation; the FEV1 was reduced and she underwent a chest tomography with diffuse ground glass opacities and irregular reticular thickening of the subpleural interstitium; interpreting the predominance of BOS (bronchiolitis obliterans syndrome) as CLAD, with presence of donor-specific antibodies (DSA). In January 2020, she received a new DLT and due to a positive crossmatch, she was treated with plasmapheresis and IgG replacement. One month after hospital discharge, no signs of rejection were observed at the BTB (bone-patellar tendon-bone) control. Between 2 to 10% of patients with primary indication of LT for IPAH are subjected to lung retransplantation (LR). The presence of DSA and HLA (human leucocyte antigen) mismatch aren鈥檛 contraindications to LR.Fil: Calder贸n Soriano, Juan C.. Fundaci贸n Favaloro; ArgentinaFil: Nazzo, Mar铆a V.,. Fundaci贸n Favaloro; ArgentinaFil: P茅rez P谩ez, Martha I.. Fundaci贸n Favaloro; ArgentinaFil: Virhuez, Yblin. Fundaci贸n Favaloro; ArgentinaFil: Balcazar, Jonathan. Fundaci贸n Favaloro; ArgentinaFil: Vicente, Luis. Fundaci贸n Favaloro; ArgentinaFil: Ahumada, Rosal铆a. Fundaci贸n Favaloro; ArgentinaFil: Osses, Juan M.. Fundaci贸n Favaloro; ArgentinaFil: Vigliano, Carlos. Consejo Nacional de Investigaciones Cient铆ficas y T茅cnicas. Oficina de Coordinaci贸n Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingenier铆a. Fundaci贸n Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingenier铆a; ArgentinaFil: Bertolotti, Alejandro Mario. Fundaci贸n Favaloro; ArgentinaFil: Caneva, Jorge O.. Fundaci贸n Favaloro; Argentin
Leucoencefalopat铆a multifocal progresiva: A prop贸sito de un caso
Progressive Multifocal Leukoencephalopathy is a disease caused
by a polimixovirus JC, which are the initials of the first patient
which was diagnosed. this disease causes demyelization of cerebral
white matter in immunocompromised patients.
It is the case of a 42-year-old man who comes to the hospital for
yellowish liquid feaces with weight loss of approximately 20 kg
and a productive cough for about a year and a half of evolution,
which is admitted with the following diagnostic impressions: Tuberculosis,
HIV-AIDS and chronic gastroenteritis. The evolution of
the patient锟絪 general condition was unfavorable due to the detection
of progressive multifocal leukoencephalopathy, and other concomitant
infections such as meningeal criptoccocosis.
There is currently no effective treatment, but studies have searched
some treatments in vitro with Mefloquine and Mirtuzapina for their
effect against JC virus. It also highlights the importance of molecular
biology techniques including the polymerase chain reaction for
diagnosis, determining the presence of the JC virus, directly linked
to the disease. It is said that PCR, NMR with typical injuries and
clinical context leads the diagnosis in 92-100%.La leucoencefalopat铆a multifocal progresiva es una enfermedad
causada por un polimixovirus JC, que son las iniciales del primer
paciente al cual se le diagnostico, esta enfermedad causa desmielinizaci贸n
de la sustancia blanca cerebral en pacientes inmunodeprimidos.
Ahora se presenta un caso cl铆nico de un paciente de 42 a帽os que
acude al hospital por deposiciones liquidas amarillentas, con p茅rdida
de peso de aproximadamente 20 kg y tos productiva de m谩s
o menos un a帽o y medio de evoluci贸n, por lo que es internado con
las siguientes impresiones diagnosticas: Tuberculosis, VIH-SIDA
y Gastroenteritis cr贸nica. La evoluci贸n del estado general del paciente
fue desfavorable debido a la detecci贸n de leucoencefalopat铆a
multifocal progresiva, adem谩s de otras infecciones concomitantes
como criptoccocosis men铆ngea.
En la actualidad no existe tratamiento eficaz, pero se est谩n realizando
estudios de algunos tratamientos in vitro con Mirtuzapina y Mefloquina
por su efecto contra el virus JC. Tambi茅n se destaca la gran
importancia de las t茅cnicas de biolog铆a molecular en particular de la
reacci贸n en cadena de polimerasa para su diagn贸stico, determinando
la presencia del virus JC, directamente ligado a la enfermedad.
Se dice que la PCR, RMN con lesiones t铆picas y un contexto cl铆nico
permite el diagnostico en un 92-100%