Severe, acute lung damage frequently results after ingestion of the herbicide, paraquat (PQ). Respiratory failure is the major cause of death in PQ-poisoned patients surviving more than 48 hours after ingestion. Prior to 1982, single lung transplantation had been performed on two occasions for patients with terminal respiratory insufficiency due to PQ toxicity. This report describes a patient in whom single lung transplantation was performed after removal of PQ. Vigorous and repetitive activated charcoal hemoperfusion treatments prior to lung transplantation were essential to diminish body stores and preclude PQ damage to the lung allograft. We confirmed that adequate removal of PQ had indeed been achieved by serial measurement of serum PQ levels and by determination of PQ tissue stores (determined by analysis of a right rectus femoris muscle biopsy) performed two days prior to transplantation. Both patients receiving lung transplants because of PQ toxicity prior to 1982 probably sustained severe PQ damage to the transplanted lung, although they may also have had allograft rejection. The recent introduction of the potent immunosuppressive agent cyclosporine has increased the success of experimental lung and clinical heart-lung allotransplantation. We utilized this drug as the major immunosuppressive agent in this patient. Unfortunately, frequent episodes of probable allograft rejection occurred nonetheless. It is possible that these rapidly developing infiltrates, accompanied by hemodynamic and gas exchange abnormalities, may have been due to ongoing Pseudomonas bronchopneumonia. However, the abruptness of onset of improvement after administration of intravenous methylprednisolone suggests that the etiology was indeed allograft rejection, despite the lack of histologic documentation. Although these episodes and the resultant requirement for large doses of corticosteroids occurred despite the use of cyclosporine immunosuppression, we were encouraged by the complete healing of the transplant bronchial anastomosis and the absence of rejection in the allografted lung at postmortem examination.
|Original language||English (US)|
|Number of pages||3|
|Journal||New York State Journal of Medicine|
|Publication status||Published - Jan 1 1984|
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