TRANSPLANTATION PNEUMONIA

Abstract

A clinically distinct pneumonitis occurred in six renal transplant recipients receiving azathioprine and prednisone immunosuppressive therapy. The patients ranged in age from 3 to 20 years. The onset was 42 to 102 days postoperatively, coinciding with decrease in prednisone dosage below approximately 1 mg per kilogram of body weight per day. Mild nonproductive cough, fever, and cynanosis were present. Chest x-rays demonstrated extensive hazy to nodular infiltrates usually involving both hila and lower lung fields. Cold agglutinins were present in five patients. Pulmonary function studies demonstrated an alveolar capillary block. The duration of illness was 12 to 34 days and was not influenced by antibiotic therapy. Autopsy of the single case in which death occurred revealed Pneumocystis carinii pneumonia and disseminated cytomegalic inclusion-body disease.

Fig 1

Relationship between daily dose of prednisone and onset of pneumonia. In each case, pneumonias appeared when prednisone was decreased below 1 mg/kg/day.

Fig 2

(Case 6). Chest x-ray demonstrating diffuse and nodular infiltrates spreading bilaterally from the hila.

Fig 3

(Case 2). Photomicrograph of lung section. Intranuclear inclusions are seen within the enlarged alveolar septal cells (× 480).