title: Interstitial pneumonitis is a frequent complication in liver transplant recipients treated with sirolimus.
abstract: BACKGROUND
  Sirolimus is a powerful immunosuppressive drug which is being used increasingly after liver transplantation because of its renal sparing and anti-tumour effects. It has been associated with uncommon, but potentially fatal, interstitial pneumonitis.
  
  
  OBJECTIVE
  To determine the frequency and outcome of sirolimus-associated pneumonitis following liver transplantation.
  
  
  METHODS
  Retrospective study in an adult liver transplant centre.
  
  
  RESULTS
  We identified five patients with siromimus-associated pneumonitis, three of whom were transplanted at our centre. Between 1999 and 2008 a total of 522 liver transplants were performed, in our unit, and 45 patients were switched from calcineurin inhibitors to sirolimus. Three of these 45 patients subsequently developed pneumonitis (6.7%). The most common presenting symptoms were cough and dyspnea. The duration of use of sirolimus before diagnosis of pneumonitis varied between 4 and 16 months. Trough serum sirolimus levels were elevated in 3/5 patients with pneumonitis. Sirolimus was withdrawn in all five patients with complete resolution of symptoms and radiological findings.
  
  
  CONCLUSIONS
  Pneumonitis is a relatively common side effect of sirolimus in liver transplant patients and can occur despite normal therapeutic blood levels. It is reversible on stopping the medication. Early recognition is important to prevent unnecessary investigations and prolonged morbidity.
authors.affiliation: National Liver Transplant Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: A
authors.initials: A
authors.lastname: Morcos
authors.forename: S
authors.initials: S
authors.lastname: Nair
authors.forename: M P
authors.initials: MP
authors.lastname: Keane
authors.forename: N G
authors.initials: NG
authors.lastname: McElvaney
authors.forename: P A
authors.initials: PA
authors.lastname: McCormick
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000097:blood; D016031:Liver Transplantation / Q000009:adverse effects*; D017563:Lung Diseases, Interstitial / Q000139:chemically induced* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D020123:Sirolimus / Q000009:adverse effects* / Q000097:blood; D013997:Time Factors; D028761:Withholding Treatment; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus