Clinical analysis of 29 cases with pneumonia in renal transplant recipients and literature review_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

PENG Zhenli ¹ , LU Bingbing ^# ,  GAO Zhancheng ¹ , QU Xingke ¹ , CAO Zhaolong ² , DONG Xiaosong ¹ , WANG Xiaofeng ¹

Departments of Respiratory and Critical Care Medicine，Peking University Peaple’s Hospital.Beijing，10044，ChinaCorresponding author：GAO Zhan-cheng，E-mail：gaozhancheng@pkuph.edu.cn;

Corresponding author：

GAO Zhancheng, Email: gaozhancheng@pkuph.edu.cn

Keywords：

Renal transplantation; Pneumonia; Cytomegalovirus

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Objective To investigate the clinical features of pnuemonia in renal transplant recipients in order to improve the clinical diagnostic and treatment efficacy.Methods 　The clinical data of 29 recipients with pneumonia following renal transplantation in Peking University People’s Hospital from January 1,1999 to July 31,2006 were collected and analyzed retrospectively.Results Of the 29 cases with pneumonia，one case（3.4%，1/29）were diagnosed as nosocomial acquired pneumonia and twenty eight cases（96.6%，28/29）as community acquired pneumonia.Of the total,cytomegalovirus （CMV） pneumonia were validated in 19 cases, bacteria pneumonia in 10 cases, fungus pneumonia in 3 cases,and Pneumocystis Carini infection in one case while none pathogen were confirmed in 5 cases with pneumonia.37.5%（9/24）cases with pneumonia which pathogen were ascertained were resulted from multiple pathogen infection.Opportunistic organism is the main pathogen of pneumonia in renal transplant recipients and the disease commonly manifested as interstitial pneumonia. 27 cases（93.1%）developed to severe pneumonia in which 15 cases were deteriorated to acute respiratory distress syndrome.Excluding 5 cases who withdrew from the hospital,4 cases （16.7%，4/24）died and 20（83.3%，20/24） cases were cured.During the second to the sixth month especially the second to the thrid month after renal transplantation the recipients were at higher-risk of pneumonia.Conclusions The majority of pneumonia in kidney recipients were severe community acquired pneumonia caused by multiple pathogens.CMV pneumonia and bacteria pneumonia are the most common types and major causes of mortality.Mortality of fungus pneumonia and CMV pneumonia are highest.Proper diagnostic procedures and therapeutic strategies are critical to improve survival rate.

Citation： PENG Zhenli,LU Bingbing,GAO Zhancheng,QU Xingke,CAO Zhaolong,DONG Xiaosong,WANG Xiaofeng. Clinical analysis of 29 cases with pneumonia in renal transplant recipients and literature review. Chinese Journal of Respiratory and Critical Care Medicine, 2008, 08(1): 20-25. doi: Copy

1.	Federle MP.Milestones and future trends in solid organ transplantation.Radiol Clin North Am，1995，33：417-434.
2.	Alangaden GJ，Thyagarajan R，Gruber SA，et al.Infectious complications after kidney transplantation：current epidemiology and associated risk factors.Clin Transplant，2006，20：401-409.
3.	Snydman DR.Epidemiology of infections after solid-organ transplantation.Clin Infect Dis，2001，33（Suppl 1）：S5-S8.
4.	Jha R，Narayan G，Jaleel MA，et al.Pulmonary infections after kidney transplantation.J Assoc Physicians India，1999，47：779-783.
5.	Murphy JF，McDonald FD，Dawson M，et al.Factors affecting the frequency infection in renal transplant recipients.Arch Intern Med，1976，136：670-677.
6.	Rubin RH.Infectious disease complications of renal transplantation.Kidney Int，1993，44：221-236.
7.	中华医学会呼吸病学分会.社区获得性肺炎诊断和治疗指南.中华结核和呼吸杂志，2006，29：651-655.
8.	中华医学会呼吸病学分会.医院获得性肺炎诊断和治疗指南（草案）.中华结核和呼吸杂志，1999，22：201-208.
9.	中华医学会呼吸病学分会.急性肺损伤/急性呼吸窘迫综合征的诊断标准（草案）.中华结核和呼吸杂志，2000，23：203.
10.	Washer GF，Schröter GP，Starzl TE，et al.Causes of death after kidney transplantation.JAMA，1983，250：49-54.
11.	Kasiske BL，Vazquez MA，Harmon WE，et al.Recommendations for the outpatient surveillance of renal transplant recipients.American Society of Transplantation.J Am Soc Nephrol，2000，11（Suppl 15）：S1-S86.
12.	Mermel LA，Maki DG.Bacterial pneumonia in solid organ transplantation.Semin Respir Infect，1990，5：10-29.
13.	Fishman JA，Rubin RH.Infection in organ-transplant recipients.N Engl J Med，1998，338：1741-1751.
14.	伍锟，张金彦，谢文菊，等.肾移植术后肺部感染状况及相关因素分析.实用预防医学，2003，10：489-490.
15.	王沛育，王素倩，冯淑青.肾移植术后肺部感染原因及诊治方法分析.中国临床医学，2006，13：637-638.
16.	Hwang EA，Kang MJ，Han SY，et al.Viral infection following kidney transplantation：long-term follow-up in a single center.Transplant Proc，2004，36：2118-2119.
17.	张鹏宇，周新，金先桥，等.无创机械通气在肾移植术后重症肺部感染合并呼吸衰竭中的应用.中国呼吸与危重监护杂志，2006，5：260-263.
18.	Grimaldi A，Barletta A，Rascente M，et al.Infectious complications in the renal transplant recipient.Transplant Proc，2005，37：2502-2503.
19.	von Müller L，Schliep C，Storck M，et al.Severe graft rejection，increased immunosuppression，and active CMV infection in renal transplantation.J Med Virol，2006，78：394-399.
20.	Radermacher J，Meiners M，Bramlage C，et al.Pronounced renal vasoconstriction and systemic hypertension in renal transplant patients treated with cyclosporin A versus FK 506.Transpl Int，1998，11：3-10.

1. Federle MP.Milestones and future trends in solid organ transplantation.Radiol Clin North Am，1995，33：417-434.
2. Alangaden GJ，Thyagarajan R，Gruber SA，et al.Infectious complications after kidney transplantation：current epidemiology and associated risk factors.Clin Transplant，2006，20：401-409.
3. Snydman DR.Epidemiology of infections after solid-organ transplantation.Clin Infect Dis，2001，33（Suppl 1）：S5-S8.
4. Jha R，Narayan G，Jaleel MA，et al.Pulmonary infections after kidney transplantation.J Assoc Physicians India，1999，47：779-783.
5. Murphy JF，McDonald FD，Dawson M，et al.Factors affecting the frequency infection in renal transplant recipients.Arch Intern Med，1976，136：670-677.
6. Rubin RH.Infectious disease complications of renal transplantation.Kidney Int，1993，44：221-236.
7. 中华医学会呼吸病学分会.社区获得性肺炎诊断和治疗指南.中华结核和呼吸杂志，2006，29：651-655.
8. 中华医学会呼吸病学分会.医院获得性肺炎诊断和治疗指南（草案）.中华结核和呼吸杂志，1999，22：201-208.
9. 中华医学会呼吸病学分会.急性肺损伤/急性呼吸窘迫综合征的诊断标准（草案）.中华结核和呼吸杂志，2000，23：203.
10. Washer GF，Schröter GP，Starzl TE，et al.Causes of death after kidney transplantation.JAMA，1983，250：49-54.
11. Kasiske BL，Vazquez MA，Harmon WE，et al.Recommendations for the outpatient surveillance of renal transplant recipients.American Society of Transplantation.J Am Soc Nephrol，2000，11（Suppl 15）：S1-S86.
12. Mermel LA，Maki DG.Bacterial pneumonia in solid organ transplantation.Semin Respir Infect，1990，5：10-29.
13. Fishman JA，Rubin RH.Infection in organ-transplant recipients.N Engl J Med，1998，338：1741-1751.
14. 伍锟，张金彦，谢文菊，等.肾移植术后肺部感染状况及相关因素分析.实用预防医学，2003，10：489-490.
15. 王沛育，王素倩，冯淑青.肾移植术后肺部感染原因及诊治方法分析.中国临床医学，2006，13：637-638.
16. Hwang EA，Kang MJ，Han SY，et al.Viral infection following kidney transplantation：long-term follow-up in a single center.Transplant Proc，2004，36：2118-2119.
17. 张鹏宇，周新，金先桥，等.无创机械通气在肾移植术后重症肺部感染合并呼吸衰竭中的应用.中国呼吸与危重监护杂志，2006，5：260-263.
18. Grimaldi A，Barletta A，Rascente M，et al.Infectious complications in the renal transplant recipient.Transplant Proc，2005，37：2502-2503.
19. von Müller L，Schliep C，Storck M，et al.Severe graft rejection，increased immunosuppression，and active CMV infection in renal transplantation.J Med Virol，2006，78：394-399.
20. Radermacher J，Meiners M，Bramlage C，et al.Pronounced renal vasoconstriction and systemic hypertension in renal transplant patients treated with cyclosporin A versus FK 506.Transpl Int，1998，11：3-10.

Chinese Journal of Respiratory and Critical Care Medicine

Clinical analysis of 29 cases with pneumonia in renal transplant recipients and literature review

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