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
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.
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BibTeX
@article{sugiura2026lateonset,
title = {{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}},
author = {Ayaka Sugiura and Kensuke Kanaoka and Maiko Naito and Takashi Kanou and Takayuki Shiroyama and Kotaro Miyake and Haruhiko Hirata and Takahiro Matsui and Yoshito Takeda and Yasushi Shintani and Atsushi Kumanogoh},
journal = {Internal Medicine},
year = {2026},
month = oct,
doi = {10.2169/internalmedicine.6307-25},
url = {https://www.jstage.jst.go.jp/article/internalmedicine/65/20/65_6307-25/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - 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
AU - Ayaka Sugiura
AU - Kensuke Kanaoka
AU - Maiko Naito
AU - Takashi Kanou
AU - Takayuki Shiroyama
AU - Kotaro Miyake
AU - Haruhiko Hirata
AU - Takahiro Matsui
AU - Yoshito Takeda
AU - Yasushi Shintani
AU - Atsushi Kumanogoh
PY - 2026
DA - 2026/10/15
JO - Internal Medicine
DO - 10.2169/internalmedicine.6307-25
UR - https://www.jstage.jst.go.jp/article/internalmedicine/65/20/65_6307-25/_article
AB - 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.
SN - 1349-7235
SN - 0918-2918
ER -