Higher Bronchiectasis Risk Reported in Renal Transplant Patients Treated with Immunosuppressive Drugs

Higher Bronchiectasis Risk Reported in Renal Transplant Patients Treated with Immunosuppressive Drugs

In a new study entitled “Bronchiectasis diagnosed after renal transplantation: a retrospective multicenter study,” researchers investigated the incidence of bronchiectasis in patients who were submitted to renal transplants and exhibited respiratory symptoms of cough and airways infections. The study was published in the journal BMC Pulmonary Medicine.

Renal transplants are one of the major solid organ transplant procedures performed throughout the world. As with other transplants, organ rejection (either acute or chronic) is the biggest concern to patients and clinicians. To halt a potential organ rejection by the patient recipient immune system, transplant patients are treated with immunosuppressive drugs, such as corticosteroids, calcineurin inhibitors (cyclosporine A, tacrolimus), and inhibitors of T- and B-cell proliferation [mycophenolic acid (MPA), including mycophenolate mofetil and mycophenolate sodium]. A key side effect with immunosuppressive drugs is a higher risk for patients to suffer from infections, in particular lung infections.

Several studies have reported patients, both adults and children, developing bronchiectasis after renal transplantation. Bronchiectasis is a condition characterized by a pathological dilatation of the bronchi, and the use of immunosuppressive drugs may lead to its onset in renal transplant patients.

In this new study, the researchers performed a retrospective multicenter study where they analyzed cases of bronchiectasis diagnosed after renal transplantation performed in 14 different renal transplantation departments in France. In total, researchers analyzed forty-six male patients, with a mean age of approximately 58 years. Patients experiencing chronic cough and sputum were identified and submitted to a chest scan. The symptoms were registered for a mean of 1.5 years before a diagnosis of bronchiectasis was made. Microbiological analysis in 22 patients identified Haemophilus influenza as the most common pathogen. In 7 patients, other pathogens identified included Streptococcus species (n = 2), Aspergillus fumigatus (n = 2), Escherichia coli (n = 2), and Pseudomonas aeruginosa (n = 1).

The findings suggest that bronchiectasis and non-cystic fibrosis patients share similar clinical and microbiological characteristics, with both type of patients exhibiting chronic sputum or recurrent bronchitis, leading to obtrusive disease with Haemophilus influenza being the main colonizing pathogen.

The research team notes that their study is the largest study addressing bronchiectasis diagnosed after renal transplantation. Additionally, authors highlight that patients who performed a renal transplant and display respiratory symptoms (including cough and infections) should be carefully monitored for the development of bronchiectasis, including computed tomography (CT) chest scans. To be determined is the potential role of immunosuppressive drugs, such as MPA, in the onset of bronchiectasis in renal transplant patients.