Document Type

Conference Proceeding

Publication Date


Publication Title

Critical Care Medicine


INTRODUCTION: Postoperative care after liver transplantation can be associated with significant cardiopulmonary complications. Thymoglobulin is used for prevention and treatment of acute rejection in organ transplantations. Although there are few case reports describing thymoglobulin induced acute respiratory distress syndrome in immunocompromised patients, there are limited reports to date on the mortality and outcomes for patients who receive extracorporeal membrane oxygenation therapy after liver transplant.

DESCRIPTION: We present a case of a 43 year old male with decompensated alcoholic cirrhosis with ascites and hepato-renal syndrome who underwent a liver transplant. Intra-operative course was complicated by vasoplegia and coagulopathy. Post-operatively, patient was on intermittent hemodialysis, on minimal ventilator settings. However, on post-operative day 2 the patient had worsening hypoxia within few hours from receiving a dose of thymoglobulin for immunosuppression. The patient had severe ARDS, with requirement of 100% Fio2 and PEEP of 20. Later in the ICU, patient developed bi-ventricular failure with ejection fraction of 30% with need for veno-arterial extracorporeal membrane oxygenation support. His course was complicated by acute kidney injury requiring slow efficiency dialysis, critical illness induced myopathy and prolonged ICU stay. He required a tracheostomy, prolonged ventilator wean and was eventually discharged home.

DISCUSSION: Our patient was diagnosed with thymoglobulin induced ARDS due to acute development of respiratory failure after thymoglobulin administration. Thymoglobulin contains cytotoxic antibodies directed against T-cell markers which can trigger immune mediated acute lung injury. The etiology of thymoglubulin-induced ARDS is not fully understood however it is regarded as a special type of transfusion-related acute lung injury characterized by acute respiratory distress during or within 6 hours after the completion of transfusion. ARDS from thymoglobulin is a rare complication however can be life-threatening. Hence it's prudent that the treating physician is aware of this potential complication which facilitates appropriate management. In our case, management included continuing steroids, utilizing ECMO, renal replacement therapy and ongoing respiratory support.





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