Multivariate Analysis Of Pneumonia, Its Related Mortality And Its Concomitant Acute Kidney Injury In Kidney Transplant Recipients

PartⅠMultivariate analysis of pneumonia in kidney transplant recipientsBackgroundThere have been few systematic investigations into risk and protective factors for pneumonia and its related mortality among renal transplant recipients.So we performed a retrospective study to investigate these factors on kidney transplant recipients at Huashan Hospital.Method213 individuals who underwent the kidney transplantation from January 2001 to July 2008 at Huashan Hospital were enrolled in this study.80 out of 213 individuals once had pneumonia after kidney transplant while the rest 133 didn't.Multivariate logistic regression was utilized to identify the risk factors for pneumonia. Mulitvariate cox regression was utilized to identify the risk factors for pneumonia related mortality.Furthermore,36 out of those 80 pneumonia patients were identified severe pneumonia.Multivariate logistic regression was utilized to identify the risk factors for severe pneumonia.Mulitvariate cox regression was utilized to identify the risk factors for severe pneumonia related mortality.ResultBy means of multivariate analysis we identified that the risk factor for pneumonia in kidney transplant recipients was initial dosage of MMF over 1.5g(odds ratio[OR]:2.122;P=0.031).The protective factor was interleukin 2 receptor antagonists as induction immunosuppression(0R:0.412;P=0.019).The risk factor for pneumonia related mortality after kidney transplant was AKI concomitant with ARDS(risk ratio[RR]:10.663;P=0.005).Moreover,we also identified the risk factor for severe pneumonia in kidney transplant recipients was the initial MMF dosage(mg/kg)at transplantation(OR:1.117; P=0.001)and body mass index(BMI,kg/m~2)prior to transplantation (OR:1.338;P=0.007).The protective factor for severe pneumonia related mortality after kidney transplant was BMI≥22kg/m~2 prior to pneumonia(OR:0.086;P=0.023).ConclusionPneumonia has a high incidence among the kidney transplant recipients.Severe pneumonia usually has a poor prognosis.Having a better understand of its risk factors is good to the prevention and treatment of pneumonia,especially severe pneumonia among the kidney transplant recipients. PartⅡConcomitant acute kidney injury in pneumonia patients after kidney transplantationBackgroundThere have been even few investigations into the concomitant acute kidney injury(AKI)in pneumonia patients after kidney transplantation. So we performed a retrospective study to investigate its risk factors and prognosis on these patients at Huashan Hospital.Method213 individuals who underwent the kidney transplantation from January 2001 to July 2008 at Huashan Hospital were enrolled in this study.80 out of the 213 individuals once had pneumonia after kidney transplantion.We calculated the concomitant AKI incidence in these pneumonia patients and evaluated its prognosis.Multivariate logistic regression was utilized to identify its risk factors.ResultAmong a total of 80 pneumonia patients,31(38.8%)had concomitant AKI,with 14(17.5%)at Stage 1,7(8.8%)at Stage 2,10(12.5%)at Stge 3.Multivariate logistic regression revealed two risk factors for it. One was severe pneumonia(OR:3.707;P=0.010)and the other was low baseline renal function defined as eGFR＜60ml/min(0R:3.790;P=0.009). The outcome of the 31 concomitant AKI patients was poor,with 3 deaths with a functioning allograft and 4 graft losses.The cost of hospitalization was higher(RMB 25521 vs 17663,P=0.001),the length of hospital stay was longer(31 days vs 21 days,P＜0.001),and the allograft survival rate at 6 month was lower(77.4%vs 93.9%,P＜0.05) in patients with concomitant AKI than that in patients without concomitant AKI.The patient survival rate was also lower in patients with concomitant AKI.However,there were no significant differences by statistical comparison(83.9%vs 95.9%,P=0.102).ConclusionPneumonia is very common after kidney transplantation.AKI is not rare during pneumonia hospitalization for kidney transplant recipients.The severity of pneumonia and baseline renal function are the independent factors for the concomitant AKI in pneumonia patients after kidney transplantation,having a better understand of which is good to the prevention of AKI among the kidney transplant recipients.