Background
Methods
Study protocol
CT scan
Statistical analysis
Results and discussion
Patient characteristics
Variables | Total (n = 46) |
---|---|
Male | 24 (52.2) |
Age (years) | 58.2 ± 13.6 [20.4–82.1] |
Duration of symptoms before diagnosis (years) | 1.5 ± 2.3 [0–12.1] |
Presenting symptoms | |
Cough and sputum > 3 months | 23 (50.0) |
Hemoptysis | 2 (4.3) |
Single respiratory tract infection | 14 (30.4) |
Recurrent bronchitis | 16 (34.8) |
Recurrent pneumonia | 9 (19.6) |
Incidental | 3 (6.5) |
Interval between first renal transplantation and first symptoms (years) | 9.1 ± 7.3 (0.2–25.3) |
Interval between first renal transplantation and diagnosis (years) | 10.9 ± 7.5 (0.4–32.0) |
Cause of end-stage renal disease | |
Chronic glomerulonephritis | 10 (21.7) |
Diabetic nephropathy | 0 (0) |
Autosomal dominant polycystic kidney disease | 15 (32.6) |
Chronic tubulointerstitial nephritis | 11 (23.9) |
Unknown cause of end-stage renal disease | 4 (8.7) |
Other renal disease | 6 (13.0) |
Age at the first renal transplantation (years) | 47.3 ± 15.1 [9.4–72.9] |
Number of renal transplantations | |
One renal transplantation | 41 (89.1) |
Two renal transplantations | 4 (8.7) |
Three renal transplantations | 1 (2.2) |
Immunosuppressive regimen | |
Induction therapy | |
Anti-lymphocyte globulins | 21 (45.7) |
Basiliximab | 8 (17.4) |
Steroids | 46 (100) |
Purine synthesis inhibitor | |
Mycophenolic acid (MPA) | 43 (93.5) |
Azathioprine | 14 (30.4) |
Calcineurin inhibitors | |
Cyclosporine | 32 (69.6) |
Tacrolimus | 15 (32.5) |
mTOR inhibitors | |
Sirolimus | 12 (26.1) |
Everolimus | 1 (2.2) |
Rituximab | 1 (2.2) |
Variables | Total (n = 46) |
---|---|
Respiratory symptom | |
Chronic cough | 3 (6.5) |
Chronic sputum | 0 (0) |
Dyspnea | 2 (4.3) |
Respiratory tract infection | 3 (6.5) |
Annual bronchitis | 2 (4.3) |
Pneumonia | 1 (2.2) |
Smoker (current or former)a | 18 (40.9) |
Pack-years | 19.4 ± 10.2 (5–40) |
Chronic obstructive pulmonary disease | 2 (4.3) |
Asthma | 1 (2.2) |
Mycobacterial infection | 1 (2.2) |
Comorbid illnesses | |
Gastroesophageal reflux disease | 17 (37.0) |
Sinusitis | 8 (17.4) |
Rheumatoid arthritis | 1 (2.2) |
CT scans
Variables | Score (n = 46) |
---|---|
Distribution of bronchiectasis | |
Localized | 7 (15.2) |
Extensive | 39 (84.8) |
Total bronchiectasis score | 7.4 ± 5.5 [1–24] |
Right upper lobe | 1 ± 1 [0–4] |
Middle lobe | 1.2 ± 1.4 [0–4] |
Right lower lobe | 1.6 ± 1.4 [0–4] |
Culmen | 0.7 ± 1.0 [0–4] |
Lingula | 1.0 ± 1.0 [0–4] |
Left lower lobe | 1.9 ± 1.5 [0–4] |
Associated signs | |
Mucoid impactions | 10 (21.7) |
Pulmonary atelectasis | 4 (8.7) |
Bronchiolar nodules | 19 (41.3) |
Pulmonary consolidations | 2 (4.3) |
Spirometry, laboratory, and microbiological data
Variables | Total (n = 46) |
---|---|
Serum creatinine (μmol/L) | 155.9 ± 83.5 [63.0–602.0] |
Creatinine clearance (mL/min, MDRD formula) | 46.4 ± 25.6 [17.0–173.0] |
Lymphocytes (/mm3) (n = 36) | 1295 ± 717 [19–3200] |
B Lymphocytes (n = 19) | 182 ± 296 [1–1194] |
T Lymphocytes (n = 19) | 781 ± 646 [17–2029] |
CD4+ T Lymphocytes (n = 19) | 562 ± 446 [9–1786] |
CD8+ T Lymphocytes (n = 19) | 352 ± 296 [8–1287] |
Electrophoresis (n = 21) | |
Gammaglobulins (g/L) | 8.0 ± 2.7 [4.0–14.0] |
Immunoglobulin assays (n = 18) | |
IgG (g/L) | 8.2 ± 3.2 [3.2–15.5] |
IgG1 (g/L) (n = 8) | 5.6 ± 3.4 [0–11.1] |
IgG2 (g/L) (n = 8) | 2.0 ± 1.3 [0–4.1] |
IgG3 (g/L) (n = 8) | 0.3 ± 0.1 [0–0.5] |
IgG4 (g/L) (n = 8) | 0.2 ± 0.3 [0–0.8] |
IgA (g/L) | 1.4 ± 0.8 [0.2–3.5] |
IgM (g/L) | 0.6 ± 0.4 [0.1–1.4] |
Hypogammaglobulinemiaa | 15 (46.9) |
MPA treatment at time of diagnosis | 42 (91.3) |
MPA daily dose (g) (n = 41) | 1.5 ± 0.6 [0.5–3.5] |
MPA area under the curve (n = 21, mg.h/L) | 42.1 ± 15.4 [20.5–80.0] |
Spirometry (n = 22) | |
Obstructive disorder | 8 (36.4) |
Microbiological data (n = 34) | |
Sputum | 4 |
Fiberoptic Bronchoscopy | 30 |
Positive microbiological findings | 22 (64.7) |
Haemophilus influenzae | 12 |
Streptococcus species | 3 |
Pseudomonas aeruginosa | 5 |
Methicillin-resistant Staphylococcus aureus | 1 |
Aspergillus fumigatus | 2 |
Other bacteria | 4 |
Initial management and outcome
Variables | Total (n = 46) |
---|---|
Medical decision at the time of diagnosis | |
MPA withdrawal | 3 |
Immunoglobulin replacement therapy | 3 |
Follow-up after diagnosis (months) | 36.3 ± 33.3 [1–150] |
Cough and chronic sputum | 20 (43.5) |
Respiratory tract infections | 17 (37.0) |
Number of episodes of acute bronchitis per year | 0.2 ± 0.5 [0–2] |
Number of episodes of pneumonitis per year | 0.07 ± 0.2 [0–0.6] |
Subsequent medical decision (n = 45) | |
Unchanged | 35 |
MPA withdrawal | 8 |
Immunoglobulin replacement therapy | 3 |
Death | 6 (13 %) |
Interval between diagnosis of bronchiectasis and death (years) | 5.3 ± 4.4 [1.2–11.0] |
Respiratory causes | 0 (0) |