Basiliximab induced non-cardiogenic pulmonary edema in two pediatric renal transplant recipients

Dolan, Niamh; Waldron, Mary; O'Connell, Marie; Eustace, Nick; Carson, Kevin; Awan, Atif

doi:10.1007/s00467-009-1244-4

Cited by 10 publications

(3 citation statements)

References 15 publications

(25 reference statements)

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“…Within the transplantation population, azathioprine, sirolimus, and everolimus are well-known in causing interstitial lung disease [7–9], with tacrolimus also being reported to induce lung injury [10,11]. T-cell targeted therapies, such as basiliximab, alemtuzumab, and anti-thymocyte immunoglobulin (ATG) have been associated with non-cardiogenic pulmonary edema in kidney transplant patients [22–25]. MMF-induced lung disease was first reported by Gross et al in 1997 [12].…”

Section: Discussionmentioning

confidence: 99%

Mycophenolate Mofetil and Pulmonary Fibrosis After Kidney Transplantation: A Case Report

Takahashi

Stone

et al. 2017

Am J Case Rep

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Patient: Male, 50Final Diagnosis: Pulmonary fibrosisSymptoms: Short of breathMedication: —Clinical Procedure: —Specialty: TransplantologyObjective:Adverse events of drug therapyBackground:Mycophenolate mofetil (MMF) induced lung disease has been described in only a few isolated reports. We report a case of fatal respiratory failure associated with MMF after kidney transplantation.Case Report:A 50-year-old Hispanic male with a history of end-stage renal disease secondary to hypertension underwent deceased donor kidney transplantation. His preoperative evaluations were normal except for a chest x-ray which showed bilateral interstitial opacities. Tacrolimus and MMF were started on the day of surgery. His postoperative course was uneventful and he was discharged on postoperative day 5. One month later, he presented with shortness of breath and a cough with blood-tinged sputum. His respiratory condition deteriorated rapidly, requiring intubation. Chest computer tomography (CT) demonstrated patchy ground-glass opacities with interlobular septal thickening. Comprehensive pulmonary, cardiac, infectious, and immunological evaluations were all negative. Open lung biopsy revealed extensive pulmonary fibrosis with no evidence of infection. He temporarily improved after discontinuation of tacrolimus and MMF, however, on resuming MMF his respiratory status deteriorated again and he subsequently died from hypoxic respiratory failure.Conclusions:An awareness of pulmonary lung disease due to MMF is important to prevent adverse outcomes after organ transplantation. MMF must be used with utmost care in recipients with underlying lung disease as their pulmonary condition might make them more susceptible to any harmful effects of MMF.

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Section: Discussionmentioning

confidence: 99%

Mycophenolate Mofetil and Pulmonary Fibrosis After Kidney Transplantation: A Case Report

Takahashi

Stone

et al. 2017

Am J Case Rep

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“…These reactions seem to occur more frequently after retreatment with basiliximab [49][50][51]. Cases of non-cardiogenic pulmonary edema have also been reported after posttransplant intravenous injection in children [52,53]. In RCTs comparing basiliximab with placebo in patients receiving dual or triple therapy with cyclosporine, no relevant side effects caused by basiliximab have been reported.…”

Section: Safety Evaluationmentioning

confidence: 94%

Basiliximab: efficacy and safety evaluation in kidney transplantation

Ponticelli

2013

Expert Opinion on Drug Safety

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There is a solid evidence that basiliximab can significantly decrease the risk of acute rejection in kidney transplant recipients without increasing adverse events. This can allow decreased dosage or avoidance of glucocorticoids and reduced dosage of calcineurin inhibitors. On the basis of efficacy, tolerability, ease of administration, and cost effectiveness, basiliximab may be considered the drug of choice for the prophylaxis of acute rejection in standard renal transplant recipients.

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“…13 Basiliximab-related noncar diogenic pulmonary edema has also been reported. 14,15 Another study reported There was no significant difference in serum creatinine between the 2 groups.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Baek

Kim²,

Yu³

et al. 2016

Exp Clin Transplant

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Objectives: Basiliximab is used alongside tacrolimusbased immunosuppression for routine induction therapy, even for well-matched living-donor renal transplant recipients. Because tacrolimus is a different drug from cyclosporine, this study examined the utility of tacrolimus-based immunosuppression without basiliximab for well-matched living-donor renal transplant recipients. Material and Methods: This prospective study evaluated 36 patients who underwent 1 to 3 human leukocyte antigens mismatched living-donor renal transplants without basiliximab induction therapy between April 2012 and March 2015 (group 1). All transplants were ABO compatible and T-flow negative and were followed until April 2015. Tacrolimus-based triple therapy was used for maintenance immunosuppression. The control group comprised 72 age-and sex-matched patients who underwent 1 to 3 human leukocyte antigens mismatched living-donor renal transplants with basiliximab induction therapy during the same period (group 2). Results: Two patients in group 1 and 12 patients in group 2 had infection,with cytomegalovirus infection and Pneumocystis pneumonia infection occurring only in group 2 and BK virus and urinary tract infection reported in both groups, with a similar incidence. One patient from group 2 had sepsis. Although the incidence of infection tended to be lower in group 1 than in group 2 (5.6% vs 16.7%), the overall incidence of infection was not significantly different (P = .135). In addition, there were no significant differences in incidence of acute rejection between groups 1 and 2 (2.8% vs 4.2%; P = .699). All patients showed stable renal function after treatment. Conclusions: Tacrolimus-based triple drug maintenance immunosuppression without basiliximab might be an optimal treatment choice for individuals undergoing well-matched living-donor renal transplant. Key words: Kidney transplantation, Tacrolimus, Basiliximab IntroductionBasiliximab is a chimeric mouse-human monoclonal antibody specific for the alpha chain (CD25) of the interleukin 2 receptor. When bound to its receptor, interleukin 2 activates intracellular signaling pathways that induce T-cell proliferation and play a key role in triggering transplant rejection. Thus, basiliximab prevents the activation of effector cells that drive alloimmune responses by inhibiting activation of the interleukin 2 receptor. 1 Randomized controlled trials have compared basiliximab with placebo in cases of kidney transplant performed under cyclosporine-based immunosuppression. The incidence of acute rejection was significantly lower in the basiliximab-treated arm, although the incidence of infection and other adverse events was generally similar between the 2 arms. 2,3 These trials showed that basiliximab is routinely used alongside tacrolimus-based immunosuppression as an agent for induction therapy even in patients who have well-matched living-donor renal transplants in Korea. Some centers in other countries omit induction therapy for such transplants, but no prospective study has exam...

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Basiliximab induced non-cardiogenic pulmonary edema in two pediatric renal transplant recipients

Cited by 10 publications

References 15 publications

Mycophenolate Mofetil and Pulmonary Fibrosis After Kidney Transplantation: A Case Report

Mycophenolate Mofetil and Pulmonary Fibrosis After Kidney Transplantation: A Case Report

Basiliximab: efficacy and safety evaluation in kidney transplantation

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