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Vol. 15. Issue 6.
Pages 1073-1099 (November - December 2009)
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Vol. 15. Issue 6.
Pages 1073-1099 (November - December 2009)
Artigo Original/Original Article
Open Access
Pulmão e transplante renal
Lung and renal transplantation
Visits
5951
Patrícia Caetano Mota1,
Corresponding author
patmota@net.sapo.pt

Serviço de Pneumologia, Hospital de S. João, EPE Alameda Professor Hernâni Monteiro 4202-451 Porto.
, Ana Paula Vaz1, Inês Castro Ferreira2, Manuela Bustorff3, Carla Damas4
1 Interna Complementar de Pneumologia, Serviço de Pneumologia, Hospital de S. João/Resident, Pulmonology, Pulmonology Unit, Hospital de S. João
2 Interna Complementar de Nefrologia, Serviço de Nefrologia, Hospital de S. João/Resident, Nephrology, Nephrology Unit, Hospital de S. João
3 Assistente Hospitalar Graduada de Nefrologia, Serviço de Nefrologia, Hospital de S. João/Consultant, Specialist, Nephrology, Nephrology Unit, Hospital de S. João
4 Assistente Hospitalar de Pneumologia, Serviço de Pneumologia, Hospital de S. João /Consultant, Pulmonology, Pulmonology Unit, Hospital de S. João
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Resumo

O transplante renal é o transplante de órgãos sólidos mais frequente, sendo os transplantados renais alvo de complicações pulmonares inerentes à própria terapêutica imunossupressora, as quais constituem, por vezes, um desafio diagnóstico e terapêutico.

Objectivo: Avaliar os doentes admitidos na Unidade de Transplante Renal (UTR) do Hospital de S. João com o diagnóstico de patologia respiratória.

Material e métodos: Estudo retrospectivo de todos os doentes admitidos na UTR por doença respiratória, durante um período de 12 meses.

Resultados: Foram incluídos 36 doentes, com uma média de idades de 55,2 (±13,4) anos; 61,1% do sexo masculino. Os esquemas imunossupressores mais utilizados foram: prednisolona e micofenolato mofetil com ciclosporina (38,9%) ou tacrolimus (22,2%) ou rapamicina (13,9%). Trinta e um doentes (86,1%) apresentaram doença infecciosa respiratória. Neste grupo destacaram-se: 23 casos (74,2%) de pneumonia, 5 casos (16,1%) de infecção oportunista, 2 (6,5%) de traqueobronquite, e 1 (3,2%) de abcessos pulmonares. O agente etiológico foi identificado em 7 casos (22,6%). Cinco doentes (13,9%) apresentaram doença pulmonar iatrogénica pela rapamicina. Em 15 doentes (41,7%) foi necessário recorrer à realização de broncofibroscopia, diagnóstica em 10 casos (66,7%). O tempo médio de internamento foi de 17,1 (±18,5) dias, e não se verificou nenhum óbito.

Conclusão: A infecção constituiu a principal complicação pulmonar no grupo de doentes estudado. O diagnóstico de doença pulmonar induzida por fármacos implica reconhecimento das suas características e monitorização rigorosa dos níveis séricos dos mesmos. O recurso a técnicas de diagnóstico invasivas contribuiu para maior precocidade e especificidade terapêuticas.

Rev Port Pneumol 2009; XV (6): 1073-1099

Palavras-chave:
Pulmão
transplante renal
imunossupressão
Abstract

Renal transplantation is the most common type of solid organ transplantation and kidney transplant recipients are susceptible to pulmonary complications of immunosuppressive therapy, which are a diagnostic and therapeutic challenge.

Aim: To evaluate patients admitted to the Renal Transplant Unit (RTU) of Hospital de S. João with respiratory disease.

Subject and methods: We performed a retrospective study of all patients admitted to RTU with respiratory disease during a period of 12 months.

Results: Thirty-six patients were included. Mean age 55.2 (±13.4) years; 61.1% male. Immunosuppressive agents most frequently used were prednisolone and mycophenolate mofetil associated with ciclosporin (38.9%) or tacrolimus (22.2%) or rapamycin (13.9%). Thirty-one patients (86.1%) presented infectious respiratory disease. In this group the main diagnoses were 23 (74.2%) pneumonias, 5 (16.1%) opportunistic infections, 2 (6.5%) tracheobronchitis, and 1 case (3.2%) of lung abscesses. Microbiological agent was identified in 7 cases (22.6%). Five patients (13.9%) presented rapamycin-induced lung disease. Fibreoptic bronchoscopy was performed in 15 patients (41.7%), diagnostic in 10 cases (66.7%). Mean hospital stay was 17.1 (±18.5) days and no related death was observed.

Conclusion: Respiratory infections were the main complications in these patients. Drug-induced lung disease implies recognition of its features and a rigorous monitoring of drug serum levels. A more invasive diagnostic approach was determinant in the choice of an early and more specific therapy.

Rev Port Pneumol 2009; XV (6): 1073-1099

Key-words:
Lung
renal transplantation
immunosuppression
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Copyright © 2009. Sociedade Portuguesa de Pneumologia/SPP
Pulmonology
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