You are here

Home » Content

RENAL TRANSPLANTASYON SONRASI SİROLİMUS İLE İLİŞKİLİ İNTERSTİSYEL PNÖMONİ: BİR AŞIRI DUYARLILIK CEVABI MI?

SIROLIMUS ASSOCIATED INTERSTITIAL PNEUMONITIS IN A RENAL TRANSPLANT PATIENT: IS ITAHYPERSENSITIVITY RESPONSE?

Journal Name:

  • İstanbul Tıp Fakültesi Dergisi

Publication Year:

  • 2007

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Sirolimus is a maintenance immunosuppressive agent after renal transplantation. Interstitial pneumonitis due to sirolimus which had no identified infectious etiology has been recently reported. We describe a case of recurrent sirolimus associated interstitial pneumonitis after renal transplantation, on the basis of its mechanism of action. The diagnosis of sirolimus-associated pulmonary toxicity was made after an exhaustive work-up to exclude infectious causes and other pulmonary disease. Sirolimus discontinuation resulted in clinical and radiologic improvement of interstital pneumonitis within 2 weeks. The precise etiology underlying sirolimus-induced pneumonitis remains unknown. However, observations in animals and humans indicate that this agent may cause lung injury in selected cases via differential regulation of the Th1/Th2 lymphocyte balance. We thought that bronchoalveolar lavage cell counts may provide some information about the mechanism of sirolimus-induced pneumonitis.
Bookmark/Search this post with
Abstract (Original Language): 
Sirolimus renal transplantasyon sonras›nda idame tedavide kullan›lmakta olan bir immunsupresif ajand›r. Herhangi bir infeksiyöz etyolojinin saptanmad›¤› sirolimusa ba¤l› interstisyel pnömoni yak›n zamanda bildirilmifltir. Renal transplantasyon sonras› sirolimus ile iliflkili rekürren interstisyel pnömoni geçiren bir olguyu, etki mekanizmas›n› temel alarak tan›mlad›k. Bu vakada, sirolimus ile iliflkili interstisyel pulmoner toksisite tan›s›, infeksiyöz nedenleri ve di¤er pulmoner hastal›klar› d›fllamak için yap›lan ayr›nt›l› de¤erlendirme sonras›nda konulmufltur. Sirolimus tedavisinin kesilmesi iki hafta içerisinde interstisyel pnömonide klinik ve radyolojik düzelme ile sonuçlanm›flt›r. Sirolimus ile iliflkili olarak ortaya ç›kan interstisyel pnömoninin kesin etyolojisi bilinmemektedir. Bununla birlikte, hayvan ve insanlarda yap›lan araflt›rmalar bu ajan›n seçilmifl vakalarda Th1/Th2 lenfosit oran›nda de¤ifliklikler meydana getirelerek akci¤er hasar›na neden olabilece¤ini göstermektedir. Bronkoalveolar lavaj hücre say›mlar›n›n, sirolimus ile iliflkili interstisyel pnömoninin mekanizmas› ile ilgili bilgi sa¤layabilece¤ine düflünmekteyiz.
FULL TEXT (PDF): 
PDF icon arastirmax-renal-transplantasyon-sonrasi-sirolimus-ile-iliskili-interstisyel-pnomoni-bir-asiri-duyarlilik-cevabi-mi.pdf
  • 1
19-22
  • English

REFERENCES

References: 

1. B1enito AI, Furlong T, Martin PJ, Anasetti C, Appelbaum FR,
Doney K, Nash RA, Papayannopoulou T, Storb R, Sullivan KM,
Witherspoon R, Deeg HJ. Sirolimus (rapamycin) for the treatment
of steroid-refractory acute graft-versus-host disease.
Transplantation 2001; 72: 1924-1929.
2. Blazar BR, Taylor PA, Panoskaltsis-Mortari A, Vallera DA. Rapamycin
inhibits the generation of graft-versus-host disease and
graft-versus-leukemia-causing T cells by interfering with the
production of Th1 or Th1 cytotoxic cytokines. J Immunol 1998;
160: 5355-5365.
3. Cahill BC, Somerville KT, Crompton JA, Parker ST, O'Rourke
MK, Stringham JC, Karwande SV. Early experience with sirolimus
in lung transplant recipients with chronic allograft rejection.
J Heart Lung Transplant 2003; 22: 169-176.
4. Fujitani Y, Trifilieff A. In vivo and in vitro effects of SAR 943, a
rapamycin analogue, on airway inflammation and remodeling.
Am J Respir Crit Care Med 2003; 167: 193-198.
5. Groth CG, Backman L, Morales JM, Calne R, Kreis H, Lang P,
Touraine JL, Claesson K, Campistol JM, Durand D, Wramner L,
Brattstrom C, Charpentier B. Sirolimus (rapamycin)-based therapy
in human renal transplantation: similar efficacy and different
toxicity compared with cyclosporine. Sirolimus European
Renal Transplant Study Group. Transplantation 1999; 67: 1036-
1042.
6. Haczku A, Alexander A, Brown P, Assoufi B, Li B, Kay AB,
Corrigan C. The effect of dexamethasone, cyclosporine, and rapamycin
on T-lymphocyte proliferation in vitro: comparison of
cells from patients with glucocorticoid-sensitive and glucocorticoid-
resistant chronic asthma. J Allergy Clin Immunol 1994; 93:
510-519.
7. Haydar AA, Denton M, West A, Rees J, Goldsmith DJ. Sirolimus-
induced pneumonitis: three cases and a review of the literature.
Am J Transplant 2004; 4: 137-139.
8. McWilliams TJ, Levvey BJ, Russell PA, Milne DG, Snell GI. Interstitial
pneumonitis associated with sirolimus: a dilemma for
lung transplantation. J Heart Lung Transplant 2003; 22: 210-
213.
9. Morelon E, Mamzer-Bruneel MF, Peraldi MN, Kreis H. Sirolimus:
a new promising immunosuppressive drug. Towards a rationale
for its use in renal transplantation. Nephrol Dial Transplant
2001; 16: 18-20.
10. Morelon E, Stern M, Israel-Biet D, Correas JM, Danel C, Mamzer-
Bruneel MF, Peraldi MN, Kreis H. Characteristics of sirolimus-
associated interstitial pneumonitis in renal transplant patients.
Transplantation 2001; 72: 787-790.
11. Morelon E, Stern M, Kreis H. Interstitial pneumonitis associated
with sirolimus therapy in renal-transplant recipients. N Engl J
Med 2000; 343: 225-226.
12. Pham PT, Pham PC, Danovitch GM, Ross DJ, Gritsch HA,
Kendrick EA, Singer J, Shah T, Wilkinson AH. Sirolimus-associated
pulmonary toxicity. Transplantation 2004; 77: 1215-1220.
13. Powell N, Till S, Bungre J, Corrigan C. The immunomodulatory
drugs cyclosporin A, mycophenolate mofetil, and sirolimus (rapamycin)
inhibit allergen-induced proliferation and IL-5 production
by PBMCs from atopic asthmatic patients. J Allergy Clin
Immunol 2001; 108: 915-917.
14. Rabinovitch A, Suarez-Pinzon WL, Shapiro AM, Rajotte RV,
Power R. Combination therapy with sirolimus and interleukin-2
prevents spontaneous and recurrent autoimmune diabetes in
NOD mice. Diabetes 2002; 51: 638-645.
15. Singer SJ, Tiernan R, Sullivan EJ. Interstitial pneumonitis associated
with sirolimus therapy in renal-transplant recipients. N
Engl J Med 2000; 343: 1815-1816.
16. Snell GI, Levvey BJ, Chin W, Kotsimbos T, Whitford H, Waters
KN, Richardson M, Williams TJ. Sirolimus allows renal recovery
in lung and heart transplant recipients with chronic renal
impairment. J Heart Lung Transplant 2002; 21: 540-546.
17. Vlahakis NE, Rickman OB, Morgenthaler T. Sirolimus-associated
diffuse alveolar hemorrhage. Mayo Clin Proc 2004; 79:
541-545.
18. Wu T, Sozen H, Luo B, Heuss N, Kalscheuer H, Lan P, Sutherland
DE, Hering BJ, Guo Z. Rapamycin and T cell costimulatory
blockade as post-transplant treatment promote fully MHC-mismatched
allogeneic bone marrow engraftment under irradiationfree
conditioning therapy. Bone Marrow Transplant 2002; 29:
949-956.
19. Yamasaki H, Ando M, Brazer W, Center DM, Cruikshank WW.
Polarized type 1 cytokine profile in bronchoalveolar lavage T
cells of patients with hypersensitivity pneumonitis. J Immunol
1999; 163: 3516-3523.

Thank you for copying data from http://www.arastirmax.com