Analysis Of Risk And Prognostic Factors Of Severe Pulmonary Infection After Renal Transplantation

ObjectiveTo analyze the clinical features of pulmonary infection after renal transplantation,explore risk factors and prognostic factors of severe pulmonary infection after renaltransplantation, in order to reduce its mortality rate of severe pulmonary infection,improve prognosis, and provide clinical reference.MethodsThe baseline and clinical data of52cases of patients with pulmonary infectionfollowing renal transplantation were Collected. The analysis includes followingaspects, such as occurrence time, clinical manifestation, etiology characteristics,clinical outcome.52cases with pulmonary infection were divided into severe andnon-severe group. Then the risk factors of severe pulmonary infection were identifiedby using the unconditional Logistic regression analysis, and Cox proportional hazardsregression model was used to find out the risk factors for severe pulmonary infectionassociated with death.Results1. In52cases,32patients were non-severe pulmonary infection, another20belonged to severe group.49patients(94.6%) occurred infection in1year aftersurgery,35patients(67.3%) were infected between2and6months, only3patients(5.8%) happened infection after one year.2. Clinical manifestations were not typical, fever often firstly appeared, moderateand high fever(67.3%) more often appeared. The respiratory system symptomsoften were cough and expectoration, lung auscultation rales didn’t appear early,The progression of the disease developed rapidly, the symptoms and signs are notsynchronized.3. Most patients existed different degree of anemia, hypoalbuminemia, hypoxemia,and elevated blood sugar, especially in the severe pulmonary infection. The chest CT commonly showed patchy high density shadow in the the early stage ofinfection, its diagnosis accuracy rate were higher than X-ray.4.31patients(59.6%) were positive for pathogen detection, most of them werebacteria(56.3%), followed by fungi(20.3%),viruses(18.7%).5. Through individualized comprehensive treatment,14patients died, the totalmortality was26.9%,5cases comed from non-severe group, the mortality was15.63%, while another9cases comed from severe group,the mortality was ashigh as45%.6. Acute rejection (OR=3.578, P=0.001) and preoperative dialysis time (OR=2.312, P=2.312) were independent risk factors for the development of severepulmonary infection, while the prophylactic use of GCV (OR=0.546, P=0.546)was the protective factor.7. Acute rejection (RR=2.763, P=2.763) and glucose (RR=1.612, P=1.612)were independent risk factors associated with death for severe pulmonaryinfection.Conclusions（1）Pulmonary infection often happened in one year after surgery, especiallybetween2and6months.（2）Fever was the risk sign of infection, the symptoms andsigns were not synchronized.（3）Most patients existed different degree of anemia,hypoalbuminemia, hypoxemia, and elevated blood sugar, especially in the severepulmonary group.（4）Chest CT was high sensitive in the early diagnosis.（5）Mostpatients were mixed infection, the pathogen was mainly bacteria.（6）The mortality ofsevere lung infection was high, it is meaningful to understand the risk factorsassociated with death for severe pulmonary infection, in order to prevent severepulmonary infection and reduce its mortality.