RENAL TRANSPLANTASYON SONRASI SİROLİMUS İLE İLİŞKİLİ İNTERSTİSYEL PNÖMONİ: BİR AŞIRI DUYARLILIK CEVABI MI?

Abstract

Sirolimus renal transplantasyon sonrasında idame tedavide kullanılmakta olan bir immunsupresif ajandır. Herhangi bir infeksiyöz etyolojinin saptanmadığı sirolimusa bağlı interstisyel pnömoni yakın zamanda bildirilmiştir. Renal transplantasyon sonrası sirolimus ile ilişkili rekürren interstisyel pnömoni geçiren bir olguyu, etki mekanizmasını temel alarak tanımladık. Bu vakada, sirolimus ile ilişkili interstisyel pulmoner toksisite tanısı, infeksiyöz nedenleri ve diğer pulmoner hastalıkları dışlamak için yapılan ayrıntılı değerlendirme sonrasında konulmuştur. Sirolimus tedavisinin kesilmesi iki hafta içerisinde interstisyel pnömonide klinik ve radyolojik düzelme ile sonuçlanmıştır. Sirolimus ile ilişkili olarak ortaya çıkan interstisyel pnömoninin kesin etyolojisi bilinmemektedir. Bununla birlikte, hayvan ve insanlarda yapılan araştırmalar bu ajanın seçilmiş vakalarda Th1/Th2 lenfosit oranında değişiklikler meydana getirelerek akciğer hasarına neden olabileceğini göstermektedir. Bronkoalveolar lavaj hücre sayımlarının, sirolimus ile ilişkili interstisyel pnömoninin mekanizması ile ilgili bilgi sağlayabileceğine düşünmekteyiz.

Keywords

• İnterstisyel pnömoni, sirolimus, renal transplantasyon, immunsüpresif ilaçlar

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