Diffuse Alveolar Damage as an Isolated Finding after Lung Transplantation: Beneficial Effect of Corticotherapy

Abstract

Purpose Some patients (pts) after lung transplantation experienced adult respiratory distress syndrome (ARDS) in the early post-transplant period. Diffuse alveolar damage (DAD) is the histologic correlates of most patients with ARDS and can occurred as an isolated finding. The aim of this study was to report our experience with isolated DAD and to highlight the beneficial impact of corticotherapy. Methods and Materials From January 2008 through September 2012, we prospectively identified all pts with ARDS and who had undergone transbronchial lung biopsies. Courses of radiologic score, C-reactive protein level, PaO2/FiO2 ratio and sequential organ failure assessment (SOFA) score were noted after treatment by corticosteroids. Results Of the 152 lung transplanted pts, isolated DAD occurred in 8 pts (5.3%) after 7.0 ±3.6 days [range 3–13]. Pts (34.5±11.4 yrs-old) underwent 6 bilateral lung and 2 cardiopulmonary transplantations. A median of 6.5 [3-14.5] units of packed erythrocytes were transfused during the 24 hours post transplantation. All patients received corticotherapy (2mg/kg for 2 weeks). Courses of radiologic score, C-reactive protein level, PaO2/FiO2 ratio and SOFA score are summarized in figure 1 . Five pts developed pneumonia 9±3 days after corticotherapy initiation. Duration of mechanical ventilation was 29±20 days. Cellular or humoral rejection occurred in 3 and 2 pts respectively. One patient died. Conclusions Early administration of corticosteroids after isolated DAD improved dramatically the severity of lung injury and the associated generalized inflammatory state. However, the presence of isolated DAD complicated the post operative course after transplantation.