Brief Communication: Sirolimus-Associated Pneumonitis: 24 Cases in Renal Transplant Recipients

Brief Communication: Sirolimus-Associated Pneumonitis: 24 Cases in Renal Transplant Recipients

From Hôpital Saint Louis, Hôpital Necker, Hôpital Foch, Hôpital Georges Pompidou, and Hôpital Edouard Herriot, 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.

Article and Author Information

Grant Support: None.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Emmanuel Morelon, MD, PhD, Service de Néphrologie, Médecine de Transplantation et Immunologie Clinique, Université Claude Bernard Lyon 1, Hôpital Edouard Herriot, 3 place d'Arsonval, 69437 Lyon, Cedex 03, France; e-mail, emmanuel.morelon{at}chu-lyon.fr.
Current Author Addresses: Drs. Champion and Peraldi: Service de Néphrologie et de Transplantation, Hôpital Saint Louis, 1 avenue Claude Vellefaux, 75010 Paris, France.
Dr. Stern: Service de Pneumologie, Hôpital Foch, 40 rue Worth, 92150 Suresnes, France.
Dr. Israël-Biet: Service de Pneumologie, Hôpital Georges Pompidou, 20 rue Leblanc, 75015 Paris, Cedex 15, France.
Drs. Mamzer-Bruneel and Kreis: Service de Transplantation et de Réanimation, Hôpital Necker, 149 rue de Sevres, 75743 Paris, Cedex 15, France.
Dr. Porcher: Département de Biostatistique et Informatique Médicale, Hôpital Saint Louis, 1 avenue Claude Vellefaux, 75475 Paris, Cedex 10, France.
Dr. Morelon: Service de Néphrologie, Médecine de Transplantation et Immunologie Clinique, Université Claude Bernard Lyon 1, Hôpital Edouard Herriot, 3 place d'Arsonval, 69437 Lyon, Cedex 03, France.
Author Contributions: Conception and design: L. Champion, M. Stern, E. Morelon.
Analysis and interpretation of the data: L. Champion, M. Stern, D. Israël-Biet, E. Morelon.
Drafting of the article: L. Champion, M. Stern, D. Israël-Biet, E. Morelon.
Critical revision of the article for important intellectual content: L. Champion, M. Stern, D. Israël-Biet, E. Morelon.
Final approval of the article: L. Champion, M. Stern, D. Israël-Biet, M.-F. Mamzer-Bruneel, M.-N. Peraldi, H. Kreis, E. Morelon.
Provision of study materials or patients: M.-F. Mamzer-Bruneel, M.-N. Peraldi, H. Kreis.
Statistical expertise: R. Porcher.
Administrative, technical, or logistic support: D. Israël-Biet, H. Kreis.