Pulmonary complaints and lung function after pediatric kidney transplantation

Abstract

Recently four of 38 children with a kidney transplant were diagnosed with bronchiectasis. The aim of the current study was to identify patients with increased risk for pulmonary damage. In this cross-sectional observational study, children with a functioning kidney graft in the Netherlands and Antwerp, Belgium, were screened with the use of a symptom checklist and spirometry. Maximum score for upper airway complaints was 21 (normal: <8), for lower airway complaints 28 (<10). Results of FVC, FEV(1) and MEF(25) were expressed as percentage predicted for height and sex. One hundred and thirty-five patients completed the interview (122) and/or spirometry (103); 91 did both. Lower airways symptoms were above acceptable levels in 18 (14%) patients. Forty-nine patients (48%) had an abnormal lung function test: in 12 concerning FVC%, in 11 FEV(1)%, in 24 MEF(25)% and in 36 FEV(1)/FVC. Of correlations between symptomatology or spirometry data, and clinical parameters, only that between GFR and MEF(25)% was statistically significant. Children with a kidney transplant are at increased risk for obstructive lung disease. We recommend to monitor lung function during the follow-up after renal transplantation.

A Pilot Study to Examine the Effect of Chronic Treatment with Immunosuppressive Drugs on Mucociliary Clearance in a Vagotomized Murine Model

“…We chose not to include non-vagotomized animals in these studies because human lungs are denervated following transplantation and denervated mice chronically treated with immunosuppressive drugs seemed the best model for translating our findings to humans, which is our goal. Our findings do not rule out the possibility that treatment with immunosuppressive drugs could affect MCC in non-denervated animals and in humans who have not undergone lung transplantation [18] – [19] . For this reason, a group of non-vagotomized mice would be interesting to look at in future studies in order to determine the potential impact of chronic immunosuppression on MCC in transplant populations that don’t undergo denervation (i.e.…”

“…Our findings do not rule out the possibility that treatment with immunosuppressive drugs could affect MCC in non-denervated animals and in humans who have not undergone lung transplantation [18]–[19]. For this reason, a group of non-vagotomized mice would be interesting to look at in future studies in order to determine the potential impact of chronic immunosuppression on MCC in transplant populations that don’t undergo denervation (i.e.…”

Bronchiectasis in children following kidney transplantation in New Zealand

“…Another proposed mechanism is direct damage to the airway wall and this is discussed in a number of studies, including the Netherlands group who hypothesised that MMF might influence ciliary motility. They also reported resolution of respiratory symptoms in the four paediatric cases after withdrawal of MMF 5,6,9 . A clear pathological process for a direct mechanism of action on respiratory function has not yet been determined to our knowledge.…”

“…Over a decade ago, adult and paediatric kidney transplant groups from the Netherlands reported small case series of kidney transplant recipients developing bronchiectasis, both citing it as a newly emerging phenomenon 5,6 . Subsequently, seven adult cases were reported from the UK and a multicentre study across 14 French transplanting units reported 46 adult cases in 2015 7,8 .…”

“…4 Over a decade ago, adult and paediatric kidney transplant groups from the Netherlands reported small case series of kidney transplant recipients developing bronchiectasis, both citing it as a newly emerging phenomenon. 5,6 Subsequently, seven adult cases were reported from the UK and a multicentre study across 14 French transplanting units reported 46 adult cases in 2015. 7,8 At the time of the initial reports, it was suggested that bronchiectasis may be associated with the increased use of the immunosuppressive medication, mycophenolate mofetil (MMF), in place of azathioprine.…”