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Sirolimus-associated pneumonitis
Submit responseChampion et al. reported 24 cases of renal transplant recipients with sirolimus (SIR)-associated pneumonitis (1). The authors described key findings of SIR-associated pneumonitis are lymphocytic alveolitis and radiologic bronchiolitis obliterance organizing pneumonia (BOOP) (1). It would be needed to give some information in this series of patients, because SIR-associated pneumonitis remains unclear from previous case reports. First, Champion et al. did not refer to respiratory function of recipients with SIR-associated pneumonitis. It is unclear whether SIR-associated pneumonitis shows restrictive or obstructive pattern. Second, Champion and coworkers didn't show any information about the histology of SIR-associated pneumonitis. Lindenfeld JA et al. reported that 24 % of cardiac transplant recipients treated by SIR, developed BOOP, whose pathology accompanied intraalveolar plugs of granulation tissue without severe fibrosis or disruption of the lung architecture (2). How is the histology of SIR-associated pneumonitis in Champion and colleagus' study? Finally, although the authors demonstrated lymphocytosis in bronchoalveolar lavege (BAL) of reported patients, CD4/CD8 ratio of lymphocyte in BAL was not shown. Low value of such ratio is a characteristic BAL pattern in idiopathic BOOP (3).
(1) Champion L, Stern M, Israel-Biet D, et al. Sirolimus- associated pneumonitis: 24 cases in renal transplant recipients. Ann Intern Med 2006;144:505-9.
(2) Lindenfeld JA, Simon SF, Zamora MR, et al. BOOP is common in cardiac transplant recipients swithed from a calcineurin inhibitor to sirolimus. Am J Transplant 2005;5:1392-6.
(3) Mukae H, Kadota J, Kohno S, et al. Increase of activated T-cells in BAL fluid of Japanese patients with BOOP and chronic eosinophlic pneumonia. Chest 1995;108:123- 8.
Conflict of Interest:
None declared