Pulmonary capillaritis in lung transplant recipients: treatment and effect on allograft function.
The clinical outcomes of lung transplant recipients presenting with post-transplant pulmonary capillaritis have not been well described. We retrospectively reviewed 40 cases of biopsy-proven pulmonary capillaritis in lung transplant recipients. Patients presented with a clinical syndrome characterized by dyspnea, hypoxemia, abnormal chest X-ray, and a decrease in forced expiratory volume in 1 second (FEV1); 25% presented with hemoptysis, and 18% with fulminant respiratory failure. Therapy with intravenous corticosteroids resulted in clinical improvement in 17 cases (43%). A response to plasmapheresis was seen in 12 (67%) of 18 cases refractory to corticosteroids. There were 5 deaths within 3 months of diagnosis. Nine (82%) of 11 lung transplant recipients who presented with capillaritis within 4 weeks post-transplant were alive at 1 year; all but 1 patient achieved expected percent predicted FEV1 values. Only 3 (14%) of 21 who presented with capillaritis > 1 month after transplant had a >20% decrease in the FEV1 after 12 months. These results suggest that post-transplant pulmonary capillaritis is (1) likely a form of acute allograft rejection clinically and histologically distinct from typical acute rejection, (2) less responsive to corticosteroid therapy than typical acute rejection, and (3) not associated with long-term adverse effects on allograft function.
Astor
Todd L
TL
Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences Center, Denver, Colorado, USA. AstorT@pediatrics.ohio-state.edu
Weill
David
D
Cool
Carlyne
C
Teitelbaum
Isaac
I
Schwarz
Marvin I
MI
Zamora
Martin R
MR
D002196:Capillaries / Q000473:pathology*; D005260:Female; D006084:Graft Rejection; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008168:Lung / Q000098:blood supply; D008171:Lung Diseases / Q000601:surgery; D016040:Lung Transplantation; D008297:Male; D011183:Postoperative Complications; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D016896:Treatment Outcome; D014657:Vasculitis / Q000188:drug therapy* / Q000209:etiology* / Q000473:pathology
D007166:Immunosuppressive Agents