Lee H S, Huh K H, Kim Y S, Kim M S, Kim H J, Kim S I, Joo D J
Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
Transplant Proc. 2012 Jan;44(1):161-3. doi: 10.1016/j.transproceed.2011.11.059.
Sirolimus is a potent immunosuppressive agent used with increasing frequency in kidney transplantation. However, sirolimus can increase the rate of unexplained interstitial pneumonitis. The aim of this study was to evaluate the clinical characteristics of sirolimus-induced pneumonitis and the therapeutic results in renal transplant recipients.
Seventy-two patients received sirolimus, conversion or de novo regimen, at our center between January 2007 and April 2011. Twelve of the 72 patients (16.7%) developed interstitial pneumonitis. The patients were divided into three groups according to the following indications of sirolimus use: de novo, early conversion, and late conversion groups.
The mean duration of follow-up was 11.0 ± 11.5 months. The mean blood level of sirolimus measured by microparticulate enzyme immunoassay was 16.5 ± 7.4 ng/mL at the time of diagnosis. The mean time from the start of sirolimus to pneumonitis onset was 14.7 ± 8.0 months. The clinical presentation included fever, cough, dyspnea, general weakness, and periorbital edema. In most cases, radiological imaging tests revealed bilateral lower-lobe involvement. Bronchoalveolar lavage was performed in three patients and two patients showed lymphocytic alveolitis. Sirolimus was discontinued or reduced for the treatment of pneumonitis. All cases of pneumonitis were resolved within 2 to 4 weeks.
Sirolimus blood level should be monitored tightly and early intervention is important when sirolimus-induced pneumonitis is suspected.
西罗莫司是一种强效免疫抑制剂，在肾移植中的使用频率日益增加。然而，西罗莫司可增加不明原因间质性肺炎的发生率。本研究旨在评估西罗莫司所致肺炎的临床特征及肾移植受者的治疗效果。
2007年1月至2011年4月期间，72例患者在本中心接受了西罗莫司治疗，包括转换治疗方案或初始治疗方案。72例患者中有12例（16.7%）发生了间质性肺炎。根据西罗莫司使用的以下指征，将患者分为三组：初始治疗组、早期转换组和晚期转换组。
平均随访时间为11.0±11.5个月。诊断时通过微粒酶免疫测定法测得的西罗莫司平均血药浓度为16.5±7.4 ng/mL。从开始使用西罗莫司到肺炎发病的平均时间为14.7±8.0个月。临床表现包括发热、咳嗽、呼吸困难、全身乏力和眶周水肿。在大多数情况下，影像学检查显示双侧下叶受累。3例患者进行了支气管肺泡灌洗，2例患者显示淋巴细胞性肺泡炎。为治疗肺炎停用或减量西罗莫司。所有肺炎病例均在2至4周内痊愈。
应密切监测西罗莫司血药浓度，怀疑西罗莫司所致肺炎时早期干预很重要。
