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| |  ISHLT: Interstitial Pneumonitis Linked To Graft Dysfunction In Very Young Heart-Lung, Lung Transplant Patients By Lynn Haley Special to DG News
VANCOUVER, B.C. -- April 27, 2001 -- Pulmonary graft dysfunction following a heart-lung or lung transplant in infants and very young patients may be associated with a previously undiagnosed interstitial pneumonitis, according to researchers from The Children’s Hospital in Philadelphia. Their findings were presented at the 21st Annual Meeting of the International Society for Heart & Lung Transplantation held in Vancouver, Canada, April 25-28th. Researchers reviewed 45 lung or heart-lung procedures performed in children aged two to 18 months (median 5.7 months) between October of 1994 and October of 2000. Thirteen patients had acute early graft failure (AEGF). The etiology for the failure was known in eight of the patients; six were the result of adenoviral pneumonia, and two had bacterial pneumonia. Adenovirus in the transplanted lung is the usual cause of AEGF in very young recipients, the researchers said. In five of the patients, the etiology was unclear. These five patients were the focus of the study. All displayed histologic features of an interstitial pneumonitis based on data collected from medical records, clinical course and outcome, initial and follow-up biopsies. The control group comprised the eight patients whose AEGF etiology was known. None had an interstitial pneumonitis. Variables included age at transplantation, bacterial pneumonia, viral pneumonia, and administration of nebulized agents prior to the onset of AEGF. Three lung transplant patients received a transplant due to surfactant B deficiency, chronic pneumonitis of infancy, and primary pulmonary hypertension. Two patients received heart-lung transplantation due to complex congenital heart disease associated with pulmonary hypertension. Initial biopsies were done 12 to 20 days after the transplant. AEGF occurred within two weeks of transplantation in all. Open lung biopsy in all five showed evidence of widening of the interstitium, with a chronic inflammatory infiltrate and filling of the alveolar air spaces with macrophages. None had evidence of eosinophilic infiltrate, bronchiolitis obliterans, or acute cellular rejection. The five were very young, with no viral infection and no exposure to nebulized agents. Two had recovered completely; both were treated with ibuprofen. Three of the five died or underwent repeat transplantation due to persistent graft failure and were not treated with ibuprofen. Researchers say the study is too small to form definitive conclusions, but recommend caution in the use of nebulized agents in infants and very young children undergoing heart-lung, and lung transplantation. "In cases of early acute graft failure without an identifiable etiology, a trial of ibuprofen seems warranted," they say.
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