From the FDA Drug Label
In patients receiving mycophenolate mofetil (2 g or 3 g) in controlled studies for prevention of renal, cardiac or hepatic rejection, fatal infection/sepsis occurred in approximately 2% of renal and cardiac patients and in 5% of hepatic patients Respiratory Interstitial lung disorders, including fatal pulmonary fibrosis, have been reported rarely and should be considered in the differential diagnosis of pulmonary symptoms ranging from dyspnea to respiratory failure in posttransplant patients receiving mycophenolate mofetil.
The pulmonary complications following kidney transplant (renal transplant) include:
- Interstitial lung disorders
- Fatal pulmonary fibrosis These complications should be considered in the differential diagnosis of pulmonary symptoms in posttransplant patients, ranging from dyspnea to respiratory failure 1.
From the Research
Pulmonary complications after kidney transplantation include both infectious and non-infectious conditions that can significantly impact patient outcomes, with the most recent and highest quality study 2 highlighting the importance of noninfectious complications. The most common infectious complications include bacterial pneumonia, opportunistic infections like Pneumocystis jirovecii pneumonia (PJP), cytomegalovirus (CMV) pneumonitis, and fungal infections such as aspergillosis, as noted in 3. These infections are more prevalent due to immunosuppressive medications that prevent organ rejection but simultaneously reduce the body's ability to fight pathogens. Non-infectious complications include:
- Pulmonary edema, which may result from fluid overload or cardiac dysfunction
- Pleural effusions
- Pulmonary embolism
- Drug-induced lung injury from medications like sirolimus Acute respiratory distress syndrome can occur in severe cases. Patients may also experience atelectasis and respiratory muscle weakness in the immediate post-operative period. Prevention strategies include:
- Pre-transplant vaccination
- Prophylactic antimicrobials (trimethoprim-sulfamethoxazole for PJP prevention at 800/160 mg three times weekly) as mentioned in the example
- Careful fluid management
- Early mobilization
- Respiratory physiotherapy Regular monitoring of respiratory symptoms, chest imaging when indicated, and prompt intervention for suspected complications are essential for managing these conditions effectively. The risk of pulmonary complications is highest in the first six months post-transplant when immunosuppression is most intense but can occur at any time during the post-transplant period, as supported by 4 and 5.