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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)
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Lung and renal transplantation
Pulmão e transplante renal
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Patrícia Caetano Mota1,5,
Corresponding author
patmota@net.sapo.pt

Serviço de Pneumologia, Hospital de S. João, EPE, Alameda Professor Hernâni Monteiro, 4202-451 Porto.
, Ana Paula Vaz1,5, Inês Castro Ferreira2,5, Manuela Bustorff3,5, Carla Damas4,5, Venceslau Hespanhol5,6
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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Article information
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.

Key-words:
Lung
renal transplantation
immunosuppression
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.

Palavras-chave:
Pulmão
transplante renal
imunossupressão
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