Clinical Analysis Of 19 Cases With Pulmonary Infection In Renal Transplant Recipients

Objective:To investigate the clinical features of pneumonia in renal transplant recipients in order to improve its cure rate.Methods:The clinical data of 19 recipients with pneumonia following renal transplantation in The First Affiliated Hospital of KunMing Medical college from June 1, 2008 to June 31,2010 were collected and analyzed retrospectively. Find out the risk factors, the risk time, the clinical features and sum up the experiences of earlier clinical diagnostic, treatment and prognosis.Results:8 cases might have risk factors of pneumonia around the period of renal transplant.68.42%(13/19) cases occurred in the first 6 months after the renal transplantation. Fever was a common early symptoms in 73.68% cases. Chest CT showed diffuse lung changes in 53.63%(10/19) cases. In the 19 cases,3 cases with pneumonia which pathogen were ascertained, bind to clinic,9 cases (47.37%) were resulted from multiple pathogen infection,8 cases (42.11%) were resulted from invasive fungal infection. The percentage of neutrophilic granulocyte, the number of neutrophilic granulocyte and lymphocytes and CD4+ T lymphocyte, the ratio of T lymphocyte CD4+/ CD8+ were difference before and after pneumonia (P<0.05). The level of serum creatinine had no difference before and after reduced the dosage or withdrawn the immunosuppressants (P>0.05).2 cases(10.35%,2/19) died and 16 cases (84.21%,16/19) were cured.Conclusions:Preoperative chronic medical conditions, rejection, immunodeficiency are risk factors of pneumonia after the renal transplantation. During the second to the sixth month after renal transplantation the recipients were at higher-risk of pneumonia. Fever is a danger signal of pneumonia. HRCT is a important diagnosis method of pneumonia. The detection rate of pathogens is very low, in our organ transplantation center, most patients were developed mixed infection, and the secondly were invasive fungal infection. The decrease of lymphocytes, CD4+ T lymphocyte and the ratio of T lymphocyte CD4+/CD8+, are indicate the higher-risk of pneumonia. Conbined therapy is the main method, reduce the dosage of immunosuppressants and even withdraw them in a short period will not cause the damage of renal function, and its helps to reduce the toxicity of CNI. Severe pneumonia may suggest unfavorable prognosis.