Home palliative care for a patient with post-lung transplant lymphoproliferative disorder: A case report

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  • 肺移植後リンパ増殖性疾患患者の在宅緩和ケア

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Abstract

<p>Lung transplantation is used for end-stage respiratory failure, often resulting in improvement in the quality of life (QOL) as well as prognosis. On the other hand, when physical symptoms continue or a life-threatening condition is presented, such as a malignant tumor associated with immunosuppression, lung transplant recipients with a serious illness may benefit from palliative care, although they rarely receive it. Here, we report a patient who was able to continue employment because of collaboration between a university hospital and a palliative home care provider. A 60s female with lymphangioleiomyomatosis underwent left lung transplantation, after which a polymorphic post-transplant lymphoproliferative disorder developed in the ascending colon eight years later. Although tumor regression did not occur with immunosuppressant adjustment and rituximab treatment, the patient requested not to receive any further chemotherapy. While continuing immunosuppressive therapy at the outpatient department of a university hospital, a home doctor began palliative care, although PTLD-induced perforated peritonitis developed one year six months later. Conservative treatment was continued and immunosuppressant therapy was adjusted, resulting in improvement in the peritonitis. Palliative care at home enabled the patient to continue working. Complementary intervention with the combination of therapeutic treatment and palliative care made it possible for the patient to live at home, resulting in a good QOL along with ensured safety, even under these conditions. Palliative care may maximize the benefits of lung transplantation.</p>

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