BOOP is common in cardiac transplant recipients switched from a calcineurin inhibitor to sirolimus.
While bronchiolitis obliterans organizing pneumonia (BOOP) has been associated with the use of sirolimus (SIR), the incidence in a consecutive group of patients given SIR to replace a calcineurin-inhibitor (CI) is unknown. Twenty-nine consecutive cardiac transplant recipients were switched from a CI to SIR to ameliorate CI-associated nephropathy or coronary graft atherosclerosis. Seven patients (24%) developed BOOP. The clinical characteristics and biopsy results of these patients are presented. The clinical course and response to withdrawal of SIR in all and steroids in four of seven patients suggested the diagnosis of BOOP. Chest X-rays and CT scans showed typical findings of BOOP in all seven patients. Infection was excluded in all patients. Biopsy results were characteristic of BOOP in six of seven patients. Six patients recovered and one died. BOOP is a common and potentially serious adverse event in cardiac transplant patients switched from a CI to SIR, especially when SIR is started late post-transplantation.
Lindenfeld
Jo Ann
JA
Division of Cardiology, Department of Medicine, University of Colorado Health Sciences Center, Denver, USA. joann.lindenfeld@uchsc.edu
Simon
Shakar F
SF
Zamora
Martin R
MR
Cool
Carlyne D
CD
Wolfel
Eugene E
EE
Lowes
Brian D
BD
Ireland
Nancy
N
Keller
Karin
K
Frisk
Rhonda
R
Stepien
Linda
L
Cleveland
Joseph C
JC
Zolty
Ronald
R
D000368:Aged; D065095:Calcineurin Inhibitors; D018549:Cryptogenic Organizing Pneumonia / Q000150:complications / Q000209:etiology* / Q000473:pathology; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects* / Q000473:pathology; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000139:chemically induced / Q000517:prevention & control; D020123:Sirolimus / Q000009:adverse effects*
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D020123:Sirolimus