Dury Sandra, Colosio Charlotte, Etienne Isabelle, Anglicheau Dany, Merieau Elodie, Caillard Sophie, Rivalan Joseph, Thervet Eric, Essig Marie, Babinet François, Subra Jean-François, Toubas Olivier, Rieu Philippe, Launois Claire, Perotin-Collard Jeanne-Marie, Lebargy François, Deslée Gaëtan
Service des Maladies Respiratoires, Hôpital Maison Blanche, CHU, 45, rue de Cognacq-Jay, 51092, Reims, Cedex, France.
EA 4683 Université de Médecine et de Pharmacie, Reims, France.
BMC Pulm Med. 2015 Nov 7;15:141. doi: 10.1186/s12890-015-0133-9.
Bronchiectasis is characterized by abnormal, permanent and irreversible dilatation of the bronchi, usually responsible for daily symptoms and frequent respiratory complications. Many causes have been identified, but only limited data are available concerning the association between bronchiectasis and renal transplantation.
We conducted a retrospective multicenter study of cases of bronchiectasis diagnosed after renal transplantation in 14 renal transplantation departments (French SPIESSER group). Demographic, clinical, laboratory and CT scan data were collected.
Forty-six patients were included (mean age 58.2 years, 52.2 % men). Autosomal dominant polycystic kidney disease (32.6 %) was the main underlying renal disease. Chronic cough and sputum (50.0 %) were the major symptoms leading to chest CT scan. Mean duration of symptoms before diagnosis was 1.5 years [0-12.1 years]. Microorganisms were identified in 22 patients, predominantly Haemophilus influenzae. Hypogammaglobulinemia was observed in 46.9 % patients. Bronchiectasis was usually extensive (84.8 %). The total bronchiectasis score was 7.4 ± 5.5 with a significant gradient from apex to bases. Many patients remained symptomatic (43.5 %) and/or presented recurrent respiratory tract infections (37.0 %) during follow-up. Six deaths (13 %) occurred during follow-up, but none were attributable to bronchiectasis.
These results highlight that the diagnosis of bronchiectasis should be considered in patients with de novo respiratory symptoms after renal transplantation. Further studies are needed to more clearly understand the mechanisms underlying bronchiectasis in this setting.
支气管扩张的特征是支气管出现异常、永久性和不可逆的扩张，通常会导致日常症状和频繁的呼吸道并发症。已确定多种病因，但关于支气管扩张与肾移植之间的关联，仅有有限的数据。
我们对14个肾移植科室（法国SPIESSER组）肾移植后诊断为支气管扩张的病例进行了一项回顾性多中心研究。收集了人口统计学、临床、实验室和CT扫描数据。
纳入46例患者（平均年龄58.2岁，男性占52.2%）。常染色体显性多囊肾病（32.6%）是主要的潜在肾脏疾病。慢性咳嗽和咳痰（50.0%）是导致胸部CT扫描的主要症状。诊断前症状的平均持续时间为1.5年[0 - 12.1年]。22例患者中鉴定出微生物，主要是流感嗜血杆菌。46.9%的患者观察到低丙种球蛋白血症。支气管扩张通常广泛（84.8%）。支气管扩张总分是7.4±5.5，从肺尖到肺底有显著梯度。许多患者在随访期间仍有症状（43.5%）和/或出现反复呼吸道感染（37.0%）。随访期间有6例死亡（13%），但均与支气管扩张无关。
这些结果突出表明，肾移植后出现新发呼吸道症状的患者应考虑支气管扩张的诊断。需要进一步研究以更清楚地了解这种情况下支气管扩张的潜在机制。
