Renal Histopathological Lesions After Lung Transplantation in Patients with Cystic Fibrosis
Article first published online: 28 JUL 2008
© 2008 The Authors Journal compilation © 2008 The American Society of Transplantation and the American Society of Transplant Surgeons
American Journal of Transplantation
Volume 8, Issue 9, pages 1901–1910, September 2008
How to Cite
Lefaucheur, C., Nochy, D., Amrein, C., Chevalier, P., Guillemain, R., Cherif, M., Jacquot, C., Glotz, D. and Hill, G. S. (2008), Renal Histopathological Lesions After Lung Transplantation in Patients with Cystic Fibrosis. American Journal of Transplantation, 8: 1901–1910. doi: 10.1111/j.1600-6143.2008.02342.x
- Issue published online: 12 AUG 2008
- Article first published online: 28 JUL 2008
- Received 04 March 2008, revised 05 May 2008 and accepted for publication 28 May 2008
- CNI toxicity;
- cystic fibrosis;
- lung transplantation;
- oxalate nephropathy;
- renal biopsy
We have analyzed the evolution of renal status beyond the perioperative period in patients with cystic fibrosis (CF) undergoing lung transplantation and presented histological analysis of 15 patients biopsied for an episode of accelerated renal function loss (RFL).
Episodes of accelerated RFL after the perioperative period occurred in 32.5% of patients and significantly raised the risk of end-stage renal disease (ESRD) (p < 0.001). The histologic lesions associated with these episodes differed according to the time of onset. Early onset (10 cases) was associated with tubulointerstitial lesions in the form of oxalate nephropathy (50%) and/or a pigmented tubulopathy (80%). This latter was correlated with treatment with antiviral agents (p = 0.002) and aminoside and glycopeptide antibiotics (p = 0.03) administered in the month preceding biopsy. Lesions in late episodes of accelerated RFL (5 cases) were principally vascular: arteriosclerosis and arteriolosclerosis (p = 0.007, p = 0.00002), correlated with diabetic glomerulosclerosis or focal segmental glomerulosclerosis in the absence of prominent diabetic changes. Specific calcineurin-inhibitor nephrotoxicity was present in 93.3% of biopsies associated with thrombotic microangiopathy in 46.7% of cases.
The identification of specific etiologies of progressive kidney disease in patients with CF after lung transplantation should permit more effective post-transplant care of these patients.