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

Laure Champion, MD; Marc Stern, MD; Dominique Israël-Biet, MD, PhD; Marie-France Mamzer-Bruneel, MD; Marie-Noëlle Peraldi, MD; Henri Kreis, MD; Raphaël Porcher, MD; and Emmanuel Morelon, MD, PhD
[+] Article and Author Information

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


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@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.


Ann Intern Med. 2006;144(7):505-509. doi:10.7326/0003-4819-144-7-200604040-00009
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Between 1996 and 2003, 217 patients having renal transplantation received sirolimus therapy at the Necker Hospital in Paris, France. A total of 128 patients were switched from calcineurin inhibitors to sirolimus to avoid calcineurin inhibitor nephrotoxicity due to chronic allograft nephropathy or to treat post-transplant malignant disease, and 89 patients received sirolimus initially after transplantation. In all patients, sirolimus was used as base immunosuppressive therapy, with a targeted trough level between 12 and 20 ng/mL.

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Sirolimus-associated pneumonitis
Posted on April 21, 2006
Yujiro Kida
Tsurumi University School of Dental Medicine and Tokyo Medical and Dental University
Conflict of Interest: None Declared

Champion 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

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Summary for Patients

Twenty-Four Cases of Pneumonitis in Kidney Transplantation Recipients Receiving Sirolimus

The summary below is from the full report titled “Brief Communication: Sirolimus-Associated Pneumonitis: 24 Cases in Renal Transplant Recipients.” It is in the 4 April 2006 issue of Annals of InternalMedicine (volume 144, pages 505-509). The authors are L. Champion, M. Stern, D. Israël-Biet, M.-F. Mamzer-Bruneel, M.-N. Peraldi, H. Kreis, R. Porcher, and E. Morelon.

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