What is the risk of ILD recurrence in MDA5/Ro52 positive dermatomyositis following a lung transplantation?

The risk of ILD recurrence in MDA5/Ro52 positive dermatomyositis following a lung transplant is probably very low, although specific data is unavailable. Polymyositis was documented as the recipient diagnosis for 87 lung transplants during the time period from 1988-2022 in the United States. Dermatomyositis is not an option as a recipient diagnosis, and the specification of MDA5/Ro52 positivity is also not an available option.

There are no case reports of recurrent polymyositis-associated lung disease after lung transplantation in the United States, and there has only been one published case report worldwide (Arboleda et al., PMID 25574033).

15-year-old female, 8 months after lung transplant hospitalized and CT showed bilateral extensive and ...

The marker that might be helpful in this situation is the level of MDA5 antibody. Data including that from Muro et al., PMID 22210662 suggest that the disappearance of the MDA5 antibody is an indicator of MDA5 disease remission. This has been our experience as well. Ro52 antibody is likely to stay even when the MDA5 has normalized.

In addition, the transplanted patient will be receiving immunosuppression that should help prevent reoccurrence of the disease. I would love to use a JAK inhibitor in MDA5 ILD but because of insurance we have used MMF and tacrolimus in combination successfully in several patients recently, medications often used to prevent solid organ rejection.

It is of interest that for some reason MDA5 ILD patients have an incr...