Analysis Of Risk Factors Related To Pneumocystis Carinii Pneumonia In Living Relative Kidney Transplant Recipient

Objective:The single factor and multiple factors analysis was carried out and the risk factors related to PCP in living relative kidney transplant recipient were explored through comparing the clinical data of PCP patients and non-PCP patients,such as the donor age,the gender and age of recipient,dialysis time before kidney transplant,cytomegalovirus infection or not,diabetes or not,polycystic kidney disease,renal hypertension or not,etc.,and the laboratory test results of neutrophile granulocyte,lymphocytes,calcium ion concentration during PCP infection or other infections in the lungs or others,etc.,so as to early prevent and identify PCP.Methods: A total of 95 kidney transplant recipients treated in An hui provincial hospital from August,2010 to August,2018 were selected as the subjects of this study.The experiment was divided into two groups,namely,PCP group and non-PCP group.Two groups of patients were diagnosed with chronic renal insufficiency(CKD5)before renal transplantation and accepted a long-term and regular dialysis treatment.In addition,the kidney of all kidney transplant recipients were derived from living relative donors.After surgery,two groups of patients were treated with methylprednisolone and baltiximab for anti-rejection treatment during the induction period.Moreover,all of them were treated with oral administration of cyclosporine + Cell Cept + prednisone with conventional dose for a long time.After that,it performed the comparison between two groups of patients in donor age,recipient gender and age,dialysis time before kidney transplant,cytomegalovirus infection or not,diabetes or not,polycystic kidney disease,renal hypertension or not,and there was a difference in neutrophile granulocyte,lymphocytes,calcium ion concentration during PCP infection or other infections in the lungs or others.If there was a statistical difference,the subject ROC curve was drawn,the best predictive value was calculated,and then the single factor and multiple factors logistic analysis carried out,so as to obtain the risk factors.Result1.There was not any significant difference(P<0.05)of the PCP group and non-PCP group in terms of gender,recipient age,donor age,CMV infection,polycystic kidney disease,diabetes,renal hypertension,dialysis time before transplant and neutrophile granulocyte;2.There was a significant difference in lymphocytes and serum calcium(p<0.05).The lymphocytes were in a normal distribution.The mean value of lymphocytes(*10^9/L)of the non-PCP group was 1.2±0.62,which was significantly higher than that of PCP group(0.88±0.50).Ca was not in a normal distribution.The mean value of ca(mmol/L)of the non-PCP group was 2.27(2.18,2.39),which was significantly lower than that of2.40 of PCP group(2.30,2.47).There was a statistically significant difference in lymphocyte and serum calcium between the two groups(p<0.05).3.The ROC curve AUC value of lymphocytes in predicting PCP in living relative kidney transplant recipient was 0.652(95% CI: 0.533-0.772)and the Cut-off value was0.97 on the ROC curve,with 67.3% of sensitivity and 63.9% of specificity at the moment;4.The ROC curve AUC value of serum Ca in predicting PCP in living relative kidney transplant recipient was 0.652(95% CI: 0.528-0.775),and the Cut-off value was 2.305 on the ROC curve,with 75.0% of sensitivity and 65.3% of specificity at the moment.Conclusion1.Recipient gender and age,donor age,CMV infection,polycystic kidney disease,diabetes,renal hypertension,dialysis time before transplant,and neutrophile granulocyte are not the high risk factors;2.Lymphocyte is a protective factor for the patients with PCP in living relative kidney transplant recipient.It is necessary to pay attention to the occurrence of PCP when the patients have pulmonary imaging changes and lymphocytes is 0.97*10^9/L or less.3.Serum calcium is a risk factor for the patients with PCP in living relative kidney transplant recipient.It is necessary to pay attention to the occurrence of PCP when blood calcium is more than 2.305 mmol / L with cough and chest tightness and the pulmonary imaging is abnormal.