Analysis Of29Clinical Cases Of Pulmonary Infection After Renal Transplantation

Objective:To provide clinical evidences for the diagnosis and treatment of pulmonary infection in patients of post-renal transplantation by retrospectively analyzing the characteristics manifestation,diagnosis, treatment and outcome of pulmonary infection in renal transplantation recipients.Methods:An analysis was performed on collected data for29post-renal transplantation patients of pulmonary infection occurring from October1st2010to September30th2012. The clinical information was explored 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, APACHE â…¡ s core, outcome and so on.Results:Of the29renal transplant patients16were male patients,13female patients.Their age range from26years old to78years old and the overall mean age was52years. The different times of post-renal transplantation infection attack was found in14cases(48.28%) between1-6months,1case(3.45%) between6-12months,4cases(13.79%) were between1-4years, and10cases (34.48%) were between4-11years. In all29cases, included fever(86.21%), chest distress and tachypnea(62.07%), cough without expectoration(27.59%), cough and expectoration(10.34%), cough and hemoptysis(10.34%), chest pain(6.90%). Physical examination included without rales55.17%, moist rales34.48%, dry rales3.45%. There were26cases(89.7%) in which immunosuppressant were reduced. Twenty-six patients had diffuse inflammation in bi-lateral lungs. Nineteen cases(65.52%) were pathogen-positive. Bacteria were responsible for66.67%of the episodes,53.84%of which were Gram-negative(G-),with viruses were responsible for12.82%, fungi for15.38%, and mycoplasma for5.19%. Ten cases(34.48%)were mixed infection. A combination of implementation of appropriate antibiotics, reduction of the immunosuppressive regimen, and nutritional support were employed. Oxygenation index, high APACHE â…¡ score, and mechanical ventilation are prognostic factors with mortality rate (P<0.05). Finally,25cases were cured,2cases died and2patients refused treatment.Conclusion:Pulmonary infections after renal transplant mainly occurred within six months. Fever, chest distress and cough were the most common clinical manifestations. There were various pathogens. Mixed infection was more common. Mortality is high. Oxygenation index, high APACHE â…¡ score, and mechanical ventilation are prognostic factors with mortality rate. De-escalation therapy (DET) is an adequate initial therapy, timely adjust immunosuppressant dosage and improve nutrition are also important and necessary.