Immunosuppression cessation after lung transplantation is a disaster. Regarding the lack of organs, long waiting list of transplantation and high resource consumption of lung transplantation; any non-compliance to immunosuppressive therapy which ultimately leads to organ and patient loss is greatly discouraging. We report here two cases which stopped their immunosuppressive therapy due to familial problems. Case one: a 49-years old woman which received single lung transplantation in 2003 due to idiopathic pulmonary fibrosis. On postoperative date (POD) 30 the patient was discharged with good condition with CellCept®, cyclosporine and prednisolone as immunosuppressive regimen. Patient attended postoperative follow-ups regularly. On POD 69, patient admitted to the hospital due to fever, infection and vascular rejection which were treated successfully. Patient discontinued her immunosuppression after 6 months post-transplantation due to familial problems. Afterward, patient re-admitted on POD 249, 270 and 360; all of them with acute rejection components which were treated accordingly. The patients ultimately died one year after transplantation with graft rejection and concomitant infection. Case two: a 31-years old woman with bronchiectasia who was transplanted on 2006. Patient was discharged on POD 44 with good condition. 1.5 years later patient was re-admitted due to graft rejection and infection. She declared that her immunosuppression was discontinued for 10 days, due to familial problems. Patient was discharged with good condition but re-admitted again after 2 weeks and one month. At her last hospitalization, grade IV graft rejection accompanied with bronchiolitis obliterans-organizing pneumonia and pseudomonas infection were detected which ultimately led to death after 21 months of transplantation. These two experiments highlight the role of family support on the outcome of lung transplantation. As our experience shows, females are more prone to negative effect of familial problems on the outcome of lung transplantation.
Volume : 6
Issue : 4
Pages : 113
Transplant Research Center, Massih Daneshvari Hospital, Darabad-Niavaran, Tehran, Iran