Lung and renal transplantation
Pulmão e transplante renal
Patrícia Caetano Mota1,5,
, Ana Paula Vaz1,5, Inês Castro Ferreira2,5, Manuela Bustorff3,5, Carla Damas4,5, Venceslau Hespanhol5,6
Corresponding author
patmota@net.sapo.pt
Serviço de Pneumologia, Hospital de S. João, EPE, Alameda Professor Hernâni Monteiro, 4202-451 Porto.
Serviço de Pneumologia, Hospital de S. João, EPE, Alameda Professor Hernâni Monteiro, 4202-451 Porto.
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
5 Serviço de Pneumologia, Hospital de S. João, EPE, Porto/Pulmonology Unit, Hospital de S. João, EPE, Porto
6 Faculdade de Medicina da Universidade do Porto
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João, EPE, Alameda Professor Hernâni Monteiro, 4202-451 Porto." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Pulmão e transplante renal" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2008-12-31" "fechaAceptado" => "2009-04-20" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec160445" "palabras" => array:3 [ 0 => "Lung" 1 => "renal transplantation" 2 => "immunosuppression" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec160444" "palabras" => array:3 [ 0 => "Pulmão" 1 => "transplante renal" 2 => "imunossupressão" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Aim</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">To evaluate patients admitted to the Renal Transplant Unit (RTU) of Hospital de S. João with respiratory disease.</p> <span class="elsevierStyleSectionTitle">Subject and methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We performed a retrospective study of all patients admitted to RTU with respiratory disease during a period of 12 months.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Thirty-six patients were included. Mean age 55.2 (<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>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 (<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>18.5) days and no related death was observed.</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Objectivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar os doentes admitidos na Unidade de Transplante Renal (UTR) do Hospital de S. João com o diagnóstico de patologia respiratória.</p> <span class="elsevierStyleSectionTitle">Material e métodos</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Estudo retrospectivo de todos os doentes admitidos na UTR por doença respiratória, durante um período de 12 meses.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Foram incluídos 36 doentes, com uma média de idades de 55,2 (<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>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 (<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>18,5) dias, e não se verificou nenhum óbito.</p> <span class="elsevierStyleSectionTitle">Conclusão</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography/Bibliografia" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:35 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Worldwide Transplant Center Directory Kidney Transplants. Clinical Transplants 2000" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.M. Cecka" 1 => "P.I. Terasaki" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "editores" => "CeckaTerasaki" "paginaInicial" => "555" "paginaFinal" => "595" "serieTitulo" => "UCLA Immunogenetics Center" "serieFecha" => "2001" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2." 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