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Late-onset Acute Cellular Rejection after Lung Transplantation Triggered by a Fluctuation in the Tacrolimus Trough Level Which Was Successfully Treated with Steroid Pulse Therapy

Year: 2026

Type: article

Abstract: Acute cellular rejection (ACR) usually develops within the first year of lung transplantation. We report a case of biopsy-proven ACR occurring 18 months post-transplant that was successfully treated with steroid pulse therapy and intensified immunosuppression. Onset followed azithromycin and clofazimine for Mycobacterium abscessus, which caused the tacrolimus trough levels to drop. The patient presented with dyspnea, diffuse ground-glass opacities, and reduced lung function. Although C4d staining was positive, the absence of donor-specific antibodies and histological findings supported the diagnosis of ACR. This case highlights the need for careful monitoring of tacrolimus trough levels and a comprehensive diagnostic workup to ensure the timely and appropriate treatment of late-onset rejection.

Source: Internal Medicine

DOI: 10.2169/internalmedicine.6307-25

Authors: Ayaka Sugiura, Kensuke Kanaoka, Maiko Naito, Takashi Kanou, Takayuki Shiroyama, Kotaro Miyake, Haruhiko Hirata, Takahiro Matsui, Yoshito Takeda, Yasushi Shintani, Atsushi Kumanogoh

Institution: The University of Osaka

Language: English

Topic: Transplantation: Methods and Outcomes

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W7136199657

FWCI:

Cites: 20

Cited by:

Related to: 10