Acute interstitial pneumonitis associated pediatric acute respiratory distress syndrome in 8 recipients after liver transplantation
- Author:
- No author available
- Journal Title:
- Chinese Journal of Organ Transplantation
- Issue:
- 3
- DOI:
- 10.3760/cma.j.issn.0254-1785.2017.03.010
- Key Word:
- 急性间质性肺炎;儿童急性呼吸窘迫综合征;儿童肝移植;肺保护性通气策略;糖皮质激素;Acute interstitial pneumonitis;Pediatric acute respiratory distress syndrome;Pediatric liver transplantation;Lung protective ventilation strategy;Glucocorticoids
Abstract： Objective To summarize the clinical course of acute interstitial pneumonitis (AIP) associated pediatric acute respiratory distress syndrome (PARDS) in 8 recipients after liver transplantation,and further discuss the potential risk factors and therapeutic highlights.Methods A total of 476 pediatric patients received liver transplantation in Tianjin First Center Hospital from January 2012 to September 2016.Among them,8 cases of AIP associated PARDS in ICU were recruited in this study.Medical data including clinical presentation,ICU management and outcomes were analyzed retrospectively.Results The onset time-window of AIP associated PARDS was (2.67 ± 0.77) months after liver transplantation,and the time interval between initial symptom and ICU administration was (6.75 ± 5.82) days.Five cases had the history of acute rejection therapy,and 5 cases had CMV and/or EBV viremia history.All 8 cases received mechanical ventilation,2 cases given nasal non-invasive ventilation and the rest 6 cases given invasive ventilation,3 of which were switched to high frequency oscillatory ventilation (HFOV) combined with inhaled nitric oxide.At the stage of hypoxic climax,the fraction of inspired oxygen (FiO2) was up-regulated to 1.0 to maintain the oxygenation index (OI) of (25.24 ± 5.94).Temporary replacement of immunosuppressants with intravenous glucocorticoids was implemented in all 8 cases without acute rejection episode.Of 8 cases,2 cases died from PARDS,1 case died from portal thrombosis associated hepatic failure,and the rest 5 cases survived.Conclusion AIP associated PARDS is a critical complication with high mortality in pediatric patients after liver transplantation.Excessively strong immunosuppression therapy at early post-transplant stage shows a risk factor for AIP.Lung protective ventilation strategy and HFOV are recommended to reduce ventilator induced lung injury in pediatric patients.Temporary intravenous glucocorticoids may reduce acute inflammatory reaction in PARDS patients without increasing the risk of acute rejection.
- [1]林俊,唐雅望,郭宏波,等.肾移植后使用西罗莫司继发间质性肺炎七例[J].2011,(9).
- [2]Parth Rali,Manik Veer,Nupur Gupta,etc.Opportunistic Pulmonary Infections in Immunocompromised Hosts.[J].2016,39(2).
- [3].Pediatric acute respiratory distress syndrome: consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference.[J].2015,16(5).
- [4]O. Manuel,F. López-Medrano,L. Kaiser,etc.Influenza and other respiratory virus infections in solid organ transplant recipients[J].2014,20(s7).
- [5]Subramanian S,Austin EH,Recto M,etc.Acute sirolimus pulmonary toxicity in an infant heart transplant recipient: case report and literature review.[J].2007,26(3).
- [6]Daniel, Im,Wei, Shi,Barbara, Driscoll.Pediatric Acute Respiratory Distress Syndrome: Fibrosis versus Repair.[J].2016.
- [7]Silvia M, Hartmann,Catherine L, Hough.Argument against the Routine Use of Steroids for Pediatric Acute Respiratory Distress Syndrome.[J].2016.
- [8]Kostakis, I. D.,Sotiropoulos, G. C.,Kouraklis, G..Pneumocystis jirovecii Pneumonia in Liver Transplant Recipients: A Systematic Review[J].2014,46(9).
- [9]Klouche K,Garrigue V,Massanet P,etc.Sirolimus-associated acute respiratory distress syndrome in a renal transplant recipient.[J].2005,37(6).
- [10]C. Lumbreras,O. Manuel,O. Len,etc.Cytomegalovirus infection in solid organ transplant recipients[J].2014,20(s7).
- [11]Lim, Joel Kian Boon,Lee, Jan Hau,Cheifetz, Ira M..Special considerations for the management of pediatric acute respiratory distress syndrome[J].2016,10(7).
- [12]Thomas, Neal J.,Yehya, Nadir,Nadkarni, Vinay M.,etc.Corticosteroid exposure in pediatric acute respiratory distress syndrome[J].2015,41(9).
- [13]Bonny B, Drago,Dai, Kimura,Cynthia R, Rovnaghi,etc.Double-blind, placebo-controlled pilot randomized trial of methylprednisolone infusion in pediatric acute respiratory distress syndrome.[J].2015,16.
- [14]Judith Ju-Ming, Wong,Tsee Foong, Loh,Daniela, Testoni,etc.Epidemiology of pediatric acute respiratory distress syndrome in singapore: risk factors and predictive respiratory indices for mortality.[J].2014,2.
- [15]Wang, Wei Li,Yu, Li Xin.Acute respiratory distress attributed to sirolimus in solid organ transplant recipients[J].2015,33(1).
- [16]Torres J,Sanchez V,Delgado JF,etc.Sirolimus-associated interstitial pneumonitis in 3 heart transplant recipients.[J].2006,25(9).
- [17].Rituximab associated pneumonitis in antineutrophil cytoplasmic antibody-associated vasculitis[J].2012,18(1).
- [18]Sano,H.,Kobayashi,R.,Iguchi,A.,etc.Risk factor analysis of idiopathic pneumonia syndrome after allogeneic hematopoietic SCT in children[J].2014,49(1).
- [19]H, Lioté,F, Lioté,B, Séroussi,etc.Rituximab-induced lung disease: A systematic literature review.[J].2010,35.
- [20]Helfrich, M.,Ison, M. G..Opportunistic infections complicating solid organ transplantation with alemtuzumab induction[J].2015,17(5).