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Ann Intern Med. 2006 Apr 4;144(7):505-9.

Brief communication: sirolimus-associated pneumonitis: 24 cases in renal transplant recipients.

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  • 1Hôpital Saint Louis, Hôpital Necker, Paris, France.

Abstract

BACKGROUND:

Interstitial pneumonitis is an ill-defined side effect of sirolimus, a new immunosuppressant drug recently introduced for patients having organ transplantation.

OBJECTIVE:

To evaluate clinical and laboratory features of sirolimus-associated pneumonitis.

DESIGN:

Case series.

SETTING:

1 transplantation center in Paris, France.

PATIENTS:

24 patients who had renal transplantation and developed sirolimus-associated pneumonitis, including 8 patients previously reported.

MEASUREMENTS:

Symptoms; laboratory tests, including bronchoalveolar fluid analysis; and computed tomography (CT) of the chest.

INTERVENTION:

Withdrawal or dose reduction of sirolimus.

RESULTS:

Clinical symptoms included cough (23 patients), fatigue (20 patients), fever (16 patients), and dyspnea (8 patients). Computed tomography of the chest showed reticular and ground-glass opacities (4 patients), bronchiolitis obliterans-organizing pneumonia (19 patients), and lobar consolidation (1 patient). Bronchoalveolar lavage showed lymphocytic (19 patients) or eosinophilic (3 patients) alveolitis or pulmonary hemorrhage (2 patients). A reduction in the sirolimus dose resulted in transient clinical improvement in 2 patients, but discontinuation of drug therapy was eventually necessary in all patients. All patients recovered completely within 6 months.

LIMITATIONS:

The sirolimus trough level in patients from this single center was higher than that usually used in patients having renal transplantation.

CONCLUSION:

Lymphocytic alveolitis and radiologic bronchiolitis obliterans-organizing pneumonia are the key findings in sirolimus-associated pneumonitis. Sirolimus withdrawal was associated with recovery within 6 months.

PMID:
16585664
[PubMed - indexed for MEDLINE]
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