Abstract：
Lung transplantation, like other transplants, carries a risk of graft rejection due to genetic differences between the donor and the recipient. In this paper, we focus on antibody-mediated rejection, which can cause acute and more importantly chronic graft dysfunction and subsequently shortened allograft survival. We present the case of a 46-year-old patient who, two months after lung transplantation (LTx), developed AMR manifested by the deterioration of graft function and de novo production of donor-specific antibodies (DSA): DQ3 (DQ7, DQ8, DQ9). As the patient was after left single LTx and heavily oxygen dependent a transbronchial biopsy was deemed to be high risk and it was decided to determine the clinical significance of the detected antibodies by their ability to bind complement. The test confirmed that the detected DSAs have the ability cause cytotoxicity of the transplanted organ. After treatment with methotrexate, intravenous immunoglobulin G (IVIg) and alemtuzumab, the patient\'s condition improved and a complete decrease in DSA was obtained. However, after a year, the production of antibodies increased sharply. Treatment with IVIg, cyclophosphamide and plasmapheresis slightly improved the patient\'s condition, reducing the MFI DSA values by half, but leaving them at high levels. Based on this clinical case, we discuss problems with making a diagnosis, choosing the right AMR treatment and monitoring the patient\'s condition during treatment. We also indicate a poor prognosis in the case of the production of DSA antibodies at the DQ locus.
摘要：
肺移植,像其他移植一样，由于供体和受体之间的遗传差异，有移植排斥的风险。在本文中,我们专注于抗体介导的排斥反应，这可能导致急性，更重要的是慢性移植物功能障碍，并随后缩短同种异体移植物的存活率。我们介绍了一个46岁的病人，肺移植（LTx）后两个月，开发的AMR表现为移植物功能的恶化和供体特异性抗体（DSA）的从头产生：DQ3（DQ7，DQ8，DQ9）。由于患者在离开单一LTx和重度氧依赖性后，经支气管活检被认为是高风险的，因此决定通过其结合补体的能力来确定检测到的抗体的临床意义。试验证实，检测到的DSAs具有惹起移植器官细胞毒性的才能。用甲氨蝶呤治疗后，静脉注射免疫球蛋白G（IVIg）和阿仑单抗，患者的病情得到改善，DSA完全下降。然而,一年后,抗体的产生急剧增加。用IVIg治疗，环磷酰胺和血浆置换略微改善了患者的病情，将MFIDSA值减少一半，但让他们处于高水平。根据这个临床病例,我们讨论诊断的问题，选择正确的AMR治疗并在治疗期间监测患者的病情。我们还指出，在DQ基因座处产生DSA抗体的情况下，预后不良。
