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


METHODS
Case series.


METHODS
1 transplantation center in Paris, France.


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


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


METHODS
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.


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


CONCLUSIONS
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.
Hôpital Saint Louis, Hôpital Necker, Paris, France.
Laure
L
Champion
Marc
M
Stern
Dominique
D
Israël-Biet
Marie-France
MF
Mamzer-Bruneel
Marie-Noëlle
MN
Peraldi
Henri
H
Kreis
Raphaël
R
Porcher
Emmanuel
E
Morelon
D000328:Adult; D000368:Aged; D018893:Bronchoalveolar Lavage; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000139:chemically induced* / Q000175:diagnosis; D020123:Sirolimus / Q000008:administration & dosage / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
D007166:Immunosuppressive Agents; D020123:Sirolimus