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2025, Number 2

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Rev Mex Traspl 2025; 14 (2)

Sequential bilateral lung transplant without circulatory assistance due to hypersensitivity pneumonitis. The first case in the mexican west

Cortés-Julián G, Ferreira-Piña B, Natera-Ramírez L, Santacruz JF, Jiménez-Fernández C, Sainz-Escárrega VH, Higuera-Medina LE, Higuera-Medina CD, Aceves-Velázquez ED, Everding-Rodríguez AG, Cabada-Bauche J, Contreras-Rodríguez JL, Briseño-Hernández AA, Plascencia-Gaitán A, González-Reyes P

Language: Spanish
References: 16
Page: 92-99
PDF size: 445.69 Kb.


ABSTRACT

Introduction: hypersensitivity pneumonitis (HP) is an interstitial lung disease caused by inhalation of organic particles such as bird proteins, fungi, and bacteria. It presents in acute, subacute, and chronic forms, with symptoms including dyspnea, cough, and fever. Diagnosis criteria are the identification of the allergen, the presence of antibodies, specific radiological patterns, and lymphocytosis in bronchioloalveolar lavage. The primary treatment is avoidance of antigen exposure and the use of anti-inflammatory drugs, mainly steroids. The HP can progress to pulmonary fibrosis, with a 5-year mortality of 29% in chronic cases. For these cases, the last line of therapy is lung transplantation. Objective: to make a surgical description of the first successful case of sequential bilateral pulmonary transplantation in the Mexican West. Case presentation: a 22-year-old male patient from Guadalajara-Jalisco presented loss of functional class due to current disease, up to oxygen dependence at rest. At the age of 20, he was diagnosed with HP with a thoracoscopic lung biopsy. He received cyclosporine, nintedanib, rituximab, and high-dose prednisone as treatment. However, he presented the progression of the disease. Therefore, he was admitted to a program of intensive cardiopulmonary rehabilitation and nutritional control to undergo bilateral lung transplantation. On November 19th, we received an offer of an ideal lung donor, 19 years old, with brain death. There were no major transoperative complications; in the immediate postoperative period, he presented grade I primary graft dysfunction. The treatment was brief ventilatory support; on the 25th postoperative day, he presented acute rejection grade B1, the treatment was three steroid boluses. Finally, the patient was discharged from the hospital in good condition on day 28 post-surgery. Conclusions: sequential unassisted bilateral lung transplantation is an alternative treatment for HP; this is the first case registered in the National Transplant Registry System in Central and Western Mexico.


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