mycophenolic-acid and Pulmonary-Disease--Chronic-Obstructive

Topics: Adult; Bronchiolitis Obliterans; Cyclosporine; Drug Therapy, Combination; Female; Follow-Up Studies; Forced Expiratory Volume; Humans; Immunosuppressive Agents; Lung Transplantation; Male; Middle Aged; Mycophenolic Acid; Pulmonary Disease, Chronic Obstructive; Pulmonary Fibrosis; Reoperation; Tacrolimus; Time Factors

BK virus-associated nephropathy (BKVAN) is a relatively common cause of renal dysfunction in the first six months after renal transplantation. It arises from reactivation of the latent and usually harmless BK virus (BK virus) due to immunosuppression and other factors including some that are unique to renal transplantation such as allograft injury. BKVAN is much rarer in non-renal solid organ transplantation, where data regarding diagnosis and management are extremely limited.. We report a case of a 58-year-old man found to have worsening renal dysfunction nine months after bilateral sequential lung transplantation for chronic obstructive pulmonary disease (COPD). He had required methylprednisolone for acute allograft rejection but achieved good graft function. Urine microscopy and culture and renal ultrasound were normal. BK virus PCR was positive at high levels in urine and blood. Renal biopsy subsequently confirmed BKVAN. The patient progressed to end-stage renal failure requiring haemodialysis despite reduction in immunosuppression, including switching mycophenolate for everolimus, and the administration of intravenous immunoglobulin (IVIG).. This very rare case highlights the challenges presented by BK virus in the non-renal solid organ transplant population. Diagnosis can be difficult, especially given the heterogeneity with which BKV disease has been reported to present in such patients, and the optimal approach to management is unknown. Balancing reduction in immunosuppression against prevention of allograft rejection is delicate. Improved therapeutic options are clearly required.

Topics: BK Virus; DNA, Viral; Humans; Immunoglobulins, Intravenous; Immunosuppressive Agents; Kidney Transplantation; Lung Transplantation; Male; Methylprednisolone; Middle Aged; Mycophenolic Acid; Polyomavirus Infections; Pulmonary Disease, Chronic Obstructive; Tumor Virus Infections

The purpose of this study was to determine the utility of post-transplant serum soluble CD30 levels as a biomarker for the development of the bronchiolitis obliterans syndrome (BOS) after lung transplantation during a tacrolimus/mycophenolate mofetil-based regimen.. Soluble CD30 (sCD30) concentrations were measured prior to transplantation and in 175 samples taken after transplantation in 7 patients developing BOS and 7 non-BOS patients closely matched for age, underlying diseases, follow-up and gender.. High pre-transplant sCD30 levels dropped significantly after lung transplantation, but in the post-transplant samples no differences could be detected between patients developing BOS or not, and no changes were found prior to or during the development of BOS.. After transplantation, sCD30 levels are consistently suppressed, but BOS is not prevented, indicating that sCD30 cannot be used as a biomarker to predict BOS after transplantation in the regimen employed.

Topics: Adult; Antigens, CD; Biomarkers; Bronchiolitis Obliterans; Emphysema; Female; Graft Survival; Humans; Immunosuppressive Agents; Informed Consent; Ki-1 Antigen; Lung Transplantation; Male; Middle Aged; Mycophenolic Acid; Postoperative Complications; Predictive Value of Tests; Pulmonary Disease, Chronic Obstructive; Tacrolimus

Hypocomplementemic urticarial vasculitis is a rare disorder characterized by the presence of C1q precipitins associated with a syndrome of urticarial vasculitis, arthralgias, ocular inflammation and obstructive-lung disease. We report the case of a 48-year-old woman with hypocomplementemic urticarial vasculitis. Because of dependance to corticosteroids, cyclophosphamide-pulse therapy was started and resulted in significant clinical improvement. Mycophenolate mofetil was effective as maintenance therapy and resulted in complete resolution of rash, arthralgias, arthritis and uveitis, but had no effect on the obstructive-lung disease.

Topics: Complement C1q; Cyclophosphamide; Female; Humans; Middle Aged; Mycophenolic Acid; Pulmonary Disease, Chronic Obstructive; Vasculitis