Hypogammaglobulinemia and bronchiectasis in mycophenolate mofetil-treated renal transplant recipients: an emerging clinical phenomenon?
Hypogammaglobulinemia and bronchiectasis in mycophenolate mofetil-treated renal transplant recipients: an emerging clinical phenomenon?
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DOI：
10.1111/j.1399-0012.2010.01255.x
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发表时间：
2011-05-01
影响因子：
2.1
通讯作者：
Harper, Steven J.
中科院分区：
文献类型：
--
作者：
Boddana, Preetham;Webb, Lynsey H.;Harper, Steven J.
背景：霉酚酸酯(MMF)可抑制T细胞和B细胞的增殖，可引起获得性或继发性低丙种球蛋白血症。这一发现和随后发生的机会性感染，包括肺炎，已经在接受MMF的患者中得到报道。慢性肺部感染和低丙种球蛋白血症易导致支气管扩张，我们的目标是在我们接受MMF治疗的肾移植患者中建立这种情况的发生率和临床模式。结果：289例患者中有23例在使用霉酚酸酯后12至95个月期间反复发生严重的胸部感染(2例)。平均年龄53岁+/-17岁。有7/289例(2.4%)的肺部病变符合临床、放射学和计算机断层扫描的诊断标准。7例支气管扩张症患者血清免疫球蛋白均为低水平。3名患者有足够的样本可用于B细胞表型分析，但没有得出确凿的结果。在我们未接受MMF治疗的移植人群中没有发现移植后支扩的病例。讨论：我们报告了7例接受MMF治疗的肾移植患者发生的支扩。我们推测，低免疫球蛋白水平可能有助于这种重大肺部疾病的发展。
Background:Mycophenolate mofetil (MMF) inhibits T- and B-cell proliferation and can cause acquired or secondary hypogammaglobulinemia. This finding and the subsequent development of opportunistic infection, including pneumonia, have been reported in patients receiving MMF. Chronic pulmonary infection and hypogammaglobulinemia predispose to bronchiectasis, and we aimed to establish the incidence and clinical pattern of this condition within our MMF-treated renal transplant population.Methods:We performed a retrospective analysis of MMF-treated transplant recipients. Two hundred and eighty-nine patients were identified and for each, demographic, clinical, radiological and laboratory data from case notes and electronic records were collected.Results:Twenty-three of 289 patients had recurrent severe chest infections (> 2 episodes) between 12 and 95 months after the introduction of MMF. The mean age was 53 +/- 17 yr. Pulmonary lesions fulfilled clinical, radiographic and computerized tomography criteria for bronchiectasis in 7/289 (2.4%). All seven patients with bronchiectasis had low serum IgG levels. Three patients had sufficient samples available for B-cell phenotype analysis but no conclusive results emerged. No cases of post-transplant bronchiectasis were identified in our transplant population not receiving MMF.Discussion:We report seven cases of bronchiectasis in renal transplant patients receiving MMF. We speculate that low immunoglobulin levels may contribute to the development of this significant pulmonary disease.