Bronchiectasis in children after renal or liver transplantation: A report of five cases

Abstract

More effective immunosuppressive treatment in children following organ transplantation has significantly improved the survival of the grafts. Therefore, quality of life, long-term prognosis and adverse drug reactions have become more important. One of the main complications of immunosuppressive drugs is infections of the respiratory tract, but irreversible damage to the airways has not been described after renal or liver transplantation. Five children following transplantation of kidney or liver were referred to the Paediatric Pulmonology department because of chronic respiratory complaints. Pulmonary function tests and HRCT scan were performed as routine patient care. Four children with a renal transplant and one with a liver transplant showed chronic bronchitis and moderate to severe airways obstruction. HRCT showed bronchiectasis in all of them. We speculate that the immunosuppressive treatment (in)directly contributes to irreversible airway damage. We recommend including follow-up of lung function in the post-transplantation protocol and considering bronchiectasis in case of respiratory symptoms, to try preventing further damage to the lung.

British Thoracic Society guideline for non-CFbronchiectasis

“…Bronchiectasis can complicate most defined primary8 22 68–73 77 90–98 484 and secondary66 67 74–76 79 81 82 84 86 87 immune deficiency disorders. The mechanism is presumed to involve defective immune clearance with repeated, persistent or severe infection leading to recurrent episodes of airways inflammation, regeneration, repair and ultimately structural damage 99.…”

Pulmonary complaints and lung function after pediatric kidney transplantation

“…The most relevant one is the increased susceptibility for (opportunistic) infections, with the lung among the target sites. As the introduction of MMF in our standard immunosuppressive protocol, four out of 38 children with a kidney transplant followed in Rotterdam have been diagnosed with bronchiectasis (1). They presented with persistent productive cough and showed disturbed lung function.…”

“…Being alerted, we designed a cross‐sectional study (1) to identify pulmonary complaints and/or abnormal lung function in children with a functioning kidney transplant, and (2) to identify risk factors for disturbed lung function. In particular, we explored the hypothesis that MMF might affect respiratory symptoms and lung function.…”

Reversible chronic pulmonary fibrosis associated with MMF in a pediatric patient: A case report

“…MMF has been implicated in the development of pulmonary pathology in several situations, ranging from acute pulmonary fibrosis shortly following transplant (10–12) to more protracted cough and dyspnoea (13). It has also been implicated in the development of bronchiectasis in the paediatric post‐transplant population (14), though the mechanics of this are unknown.…”