Chest
Total Lymphoid Irradiation for Refractory Acute Rejection in Heart-Lung and Lung Allografts
Section snippets
Patients
Twenty-seven HLTs, 11 single-lung transplants (SLTs), and 6 bilateral-lung transplants (BLTs) in adults (age >18 years) were performed between August 1989 and January 1992. Six of these patients (TLI group) received TLI after repeated IV boluses of MP and optimization of cyclosporine and azathioprine therapy failed to reverse repetitive or intractable acute cellular rejection. Twenty-three of the 38 patients (rejector group) had at least one AR that required MP bolus therapy. The remaining 15
RESULTS
The clinical data of the patients who received TLI for refractory rejection are summarized in Table 1. Briefly, there were four women and two men ranging in age from 26 to 34 years with a mean and SD of 29.8±3.8. Table 2 summarizes the TLI specifications. The median pre-TLI period was 142 days (range, 37 to 707 days). The mean duration and SD of TLI was 34±4 days. The median post-TLI period to February 1,1995 was 568 days (range, 51 to 1,937 days). The overall median survival time in this
DISCUSSION
Radiotherapy for clinical transplantation was originally administered in the form of total body irradiation more than 3 decades ago to induce prolonged renal allograft acceptance.13 However, it was limited by unacceptable severe bone marrow and GI toxic reactions.
The subsequent refinements in the fractionation, dose per fraction, total radiation dose, and mode of delivery minimized the total radiation exposure and targeted the therapy to the lymphatic system. These modifications in combination
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Cited by (62)
Other forms of immunosuppression
2019, Kidney Transplantation - Principles and PracticeAcute Rejection and Antibody-Mediated Rejection in Lung Transplantation
2017, Clinics in Chest MedicineCitation Excerpt :Treatment for persistent ACR has not been investigated in the context of randomized controlled trials and is highly variable based on transplant program practices and individual patient risk factors. Options include additional bolus methylprednisolone, antithymocyte globulin, alemtuzumab, total lymphoid irradiation, and extracorporeal photopheresis.39–41 Airway inflammation often accompanies acute rejection, particularly higher grades of ACR.
Other forms of immunosuppression
2013, Kidney Transplantation-Principles and Practice, Seventh EditionLung Transplant Complications
2012, Emergency Medicine: Clinical Essentials, SECOND EDITIONAcute Allograft Rejection: Cellular and Humoral Processes
2011, Clinics in Chest MedicineCitation Excerpt :A recent report demonstrated the utility of alemtuzumab, an anti-CD52 monoclonal antibody, in the treatment of refractory acute rejection in a small cohort of patients who previously failed treatment with ATG.39 Other therapies that have been considered include inhaled cyclosporine,92,93 extracorporeal photopheresis,94 and total lymphoid irradiation.95 The relationship between acute rejection, its current treatments, and the eventual occurrence of BOS is an area of considerable interest.
Pathology of Lung Transplantation
2011, Practical Pulmonary Pathology E-Book: A Diagnostic Approach, Second Edition