Histological Spectrum of Pulmonary Manifestations in Kidney Transplant Recipients.
Sean Kirby, Anjali Satoskar, Sergey Brodsky, Amy Pope-Harman, David Nunley, Charles Hitchcock, Ronald Pelletier, Tibor Nadasdy, Konstantin Shilo. The Ohio State University, Columbus
Background: After the introduction of novel effective immunosuppressive therapies, kidney transplantation became the treatment of choice for end stage renal disease (ESRD). While these new therapies lead to increased graft survival, they can also cause unwanted complications. Only small series or case reports describe pulmonary pathology in renal allograft recipients. Therefore, we undertook a systematic review of all lung biopsy specimens of kidney transplant recipients and report a spectrum of histological findings.
Design: Laboratory information system database search (from January 2002-2010) revealed 28 renal allograft recipients who required a lung biopsy for respiratory symptoms. They included 19 males and 9 females, 25 to 77 years old (mean age 53 years) and comprised approximately 1% of over 2,100 kidney transplant recipients. There were 41 biopsies including 7 (17%) open lung biopsies. Retrospective analysis of electronic clinical records and correlation with histological findings were performed.
Results: The time from transplantation to lung biopsy ranged from 4 to 345 months (mean 81 months). The majority of patients (15/28 or 54%) received a deceased donor kidney. The main cause of ESRD was diabetic nephropathy (10/28; 36%). Immunosuppression regimen of 16 (57%) patients included Rapamycin. Based on chest CT findings, 9 (32%) patients had diffuse process (ground glass opacities and/or reticulations including 2 with five-lobe consolidation). Localized lesions, including nodules or mass-like consolidation, were seen in 19 (68%) patients. Among 9 patients with diffuse lung disease, biopsy revealed diffuse alveolar hemorrhage as predominant finding in 5 cases, organizing pneumonia in 1 and diffuse alveolar damage in 1 case. Three of 9 with diffuse lung disease had clinical concern for Rapamycin toxicity and improved after drug discontinuation. In 19 patients with localized lesions, biopsy showed neoplasia in 8, necrotic nodules/granulomas in 5, and organizing pneumonia in 1 case. Lung biopsies in 8 (29%) patients had only minimal/nonspecific findings.
Conclusions: Pulmonary changes requiring tissue diagnosis are uncommon in kidney transplant recipients. Among localized lesions, the majority are infectious nodules and neoplasms. Histological spectrum among diffuse lung diseases includes diffuse pulmonary hemorrhage and acute lung injury. Together with infectious etiology, Rapamycin toxicity becomes another important differential diagnostic consideration in these patients.
Wednesday, March 2, 2011 9:30 AM
Poster Session V # 271, Wednesday Morning