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

  1. Laure Champion, MD;
  2. Marc Stern, MD;
  3. Dominique Israël-Biet, MD, PhD;
  4. Marie-France Mamzer-Bruneel, MD;
  5. Marie-Noëlle Peraldi, MD;
  6. Henri Kreis, MD;
  7. Raphaël Porcher, MD; and
  8. Emmanuel Morelon, MD, PhD
  1. 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.

    Comments on This Article

    • Sirolimus-associated pneumonitis
      • Yujiro Kida
      Ann Intern Med published online April 21, 2006

    Summary for Patients

    • Summaries for Patients: Twenty-Four Cases of Pneumonitis in Kidney Transplantation Recipients Receiving Sirolimus Ann Intern Med April 4, 2006 144:I-45
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    This Article

    1. Ann Intern Med April 4, 2006 vol. 144 no. 7 505-509
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