Clinical Analysis Of 39 Cases With Pulmonary Invasive Fungal Disease In Renal Transplant Recipients

As the most effective treatment of the end stage renal disease,kidney transplantation is the most matura technology in clinical.in 2012,《lancent》first report of Chronic kidney disease in China shows:in china,the Morbidity if Chronic kidney disease is 10.8%,which accounts for 195 million patients,and the Morbidity incrsases with age.kidney transplantation is beening wildly used as the most ideal replacement therapy for patients in CKD,according to the data from Chinese Scientific Registry of Kidney Transplantation Data Center,7131 kidney transplantation had been achieved in 2015.however,with the extensive use of the new immunosuppressant and broad-spectrum antibiotic,the infection after surgery affects the survival rate badly.especially the invasive fungus disease,which attacks dormantly without any specific clinical features,is one of the most important reasons patients lost their graft.Now,epidemiological research domestic and overseas shows:the morbidity depends on the level of immune,tne environment of transplantation center and many other factors.TRANSNET of US indicated that maong IPD patients,the most common pathogenic fungi is Monilia,fellowed by the invasive Aspergillus,Crytococcus,the non-invasive Aspergillus,the local fungal infection,the Zygomycete.Data shows different degree and type infections occure in about 75 percent pantients after transplantation,among whom about 26 percent patients died.from infection.Though invasive pulmonary fungal disease cause more and more attention,but the etiology and pathogenesis although hard to be confirmed.there’s no large-scale of evidence-based medicine in china,which cause no standard therapy and most treatment depend on clinician’s experience.So,analyze of the clinical features for IPID after kidney transplantation is very necessary to improve the survival rate.Objective To investigate the clinical features of the petients with invasive pulmonary fungal disease after kidney transplantation,to discuss the therapeutic regimen of invasive pulmonary fungal disease after kidney transplantationMethod retrospective analysis 346 patients after kidney transplantation in zhujiang hospital,filtrate patients with IFID according to standard,into death and survive during hospitalization.analysis the morbidity,death rate,constitute of pathogenic bacteria and effectiveness of antifungal agents.Result 39 cases were diagnosed as IPID after kidney transplantation,30 were males and 9 were females,the mean age is(46.25±11.483).there are 5 cases(12.8%)get the infection between 1-3 months after operation,18 cases(46.15%)between 3-6 months,25 cases(64.1%)in12 months,8 cases(20.51%)between 12-24 months after surgery.Chest imaging findings:exudative lesions 21cases,patched shadow 8 cases,multiple nodules 4 cases,increased bronchovascular shadows 4 cases,single nodules 3 cases,barren shadow 1 cases.Conclusion Most cases occurred in 3-6 months after operation,most patients see a doctor on account of fever and cough,and clinical features were absent.relevance ratio of pathogenic bacteria is low,Monilia albicans is the most common pathogenic bacteria(36%),chest imagings are diversified,which has guidance to clinical diagnosis.IPID after kidney transplantation develop rapidly,it’s important to identify pathogenic bacteria and choose sensitive antifungal agents in early stage,which can save resource and shorten course of treatment.