Clinical Analysis Of 15 Cases With Pulmonary Infection After Renal Transplantation

Objective: To provide clinical evidences for the prevention and treatment of pulmonary infection in patients of post-renal transplantation and of kidney disease by retrospectively analyzed the treatment and outcome of pulmonary infection in renal transplantation recipientsMethods: An analysis was performed on collected data for 15 post-renal transplantation patients (16 cases) of pulmonary infection occurring from March 2003 to October 2009. The clinical information was studied retrospectively, including gender, age, onset time, symptoms and physical signs, pathogen diagnosis, laboratory test results, chest X-ray results, anti-infective regimen, adjustment of the immunosuppressive therapy, APACHEⅡscore, outcome, and so on.Results: In all 16 cases, the different times of post-renal transplantation infection attack was found in 9 cases (56.25%) between 2-6 months, 1 case (6.25%) between 7-12 months, 1 case (6.25%) between 1-3 years, and 5 cases (31.25%) after 3 years. Clinical symptoms included fever (93.75%), cough and expectoration (50%), chest tightness (25%), chest pain (6.25%), shortness of breath (6.25%), and cyanosis (6.25%). The mean serum creatinine (Scr) at the admission day was 188.4±113.1μmol/L. There were 14 cases in which immunosuppressants were reduced, and the mean Scr was 184.9±108.5μmol/L at beginning and 178.4±113.3μmol/L at end (P>0.05). At the admission day, the CsA concentration≥200ng/ml 7 cases, <100ng/ml 1 case, the mean concentration of CsA was 222.43±86.78ng/ml. 12 cases (75%) were pathogen-positive. Bacteria were responsible for 66.7% of the episodes, 68.8% of which were Gram-negative (G-), with viruses were responsible for 16.7%, fungi for 8.3%, and Chlamydia for 8.3%. 6 cases (50%) were mixed infection. A combination of implementation of appropriate antibiotics, reduction of the immunosuppressive regimen, and nutritional support were employed. Mixed infection, oxygenation index, and high APACHEⅡscore are prognostic factors with mortality rate (P<0.05). Finally, 9 cases (56.25%) were cured, 5 cases (31.25%) died, and 2 patients refused treatment.Conclusion: Pulmonary infections after renal transplant mainly occurred within six months. Fever and cough were the most common clinical manifestations. There were various pathogens, including bacteria, cytomegalovirus and fungi. Mixed infection was more common. Mortality is high. Combined anti-infective drugs at early stage, timely adjust immunosuppressant dosage, improve nutrition should be employed. Generally, adjusting the dosage of immunosuppressive agents did not lead to deterioration of renal function.