HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Walter Klepetko Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Aigner, C. Articles by Klepetko, W. Search for Related Content PubMed PubMed Citation Articles by Aigner, C. Articles by Klepetko, W. Related Collections Lung - transplantation

Eur J Cardiothorac Surg 2004;25:184-187
© 2004 Elsevier Science NL

Treatment of severe acute lung allograft rejection with OKT3 and temporary extracorporeal membrane oxygenation bridging

Department of Cardiothoracic Surgery, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria

Received 16 September 2003; received in revised form 28 October 2003; accepted 10 November 2003.

^* Corresponding author. Tel.: +43-1-40-400-5644; fax: +43-1-40-400-5642
e-mail: walter.klepetko{at}akh-wien.ac.at

Objectives: The use of OKT3 for treatment of advanced high-grade acute rejection episodes eventually can result in cytokine release and consecutive pulmonary edema. Temporary extracorporeal membrane oxygenation (ECMO) bridging can be used to overcome this crucial period before the beneficial effects of OKT3 can be observed. Methods: We summarize our experience with three patients, who underwent lung transplantation and presented with severe acute rejection episodes. OKT3 had to be initiated due to insufficient response to standard rejection therapy with corticosteroids. Upon initiation of OKT3 treatment, a massive life-threatening deterioration of lung function in spite of heavily invasive respirator treatment was seen and temporary ECMO support was imperative to support graft function. Results of this treatment were retrospectively reviewed. Results: In all cases femoro-femoral veno-arterial ECMO was used for support of the impaired graft and after a period of 4–5 days led to a massive improvement of graft function. In the further course two patients could be discharged from hospital and are still alive 30 and 36 months, respectively, after the described incident. One patient died 4 months later due to liver failure. Conclusions: We conclude that the use of ECMO support in patients experiencing significant side effects from OKT3 therapy is a useful and effective therapeutic tool to overcome the initial critical period until the lung has sufficiently recovered.

Key Words: Lung transplantation • Extracorporeal membrane oxygenation • OKT3 • Acute rejection • Steroid-resistant rejection

This article has been cited by other articles:

				D. P. Mason, D. J. Boffa, S. C. Murthy, T. R. Gildea, M. M. Budev, A. C. Mehta, A. M. McNeill, N. G. Smedira, J. Feng, T. W. Rice, et al. Extended use of extracorporeal membrane oxygenation after lung transplantation J. Thorac. Cardiovasc. Surg., October 1, 2006; 132(4): 954 - 960. [Abstract] [Full Text] [PDF]

				D. Zimpfer, B. Heinisch, M. Czerny, T. Hoelzenbein, S. Taghavi, E. Wolner, and M. Grimm Late Vascular Complications After Extracorporeal Membrane Oxygenation Support. Ann. Thorac. Surg., March 1, 2006; 81(3): 892 - 895. [Abstract] [Full Text] [PDF]