Clinical Analysis Of Risk Factors For Pneumocystis Jirovecii Pneumonia After DCD Kidney Transplantation

Objective:The clinical manifestations of pneumocystis jirovecii pneumonia after kidney transplantation the disease progresses rapidly,and the mortality rate is high.Early intervention can significantly reduce the incidence and mortality of the disease.The purpose of this study was to investigate the risk factors associated with renal transplant recipients and to analyze the clinical data of patients with PJP,so as to facilitate early effective interventions and treatment to reduce the incidence and mortality of PJP after transplantation.Methods:This study retrospectively analyzed the data of 22 patients diagnosed with PJP after kidney transplantation from September 2015 to September 2019 in The Tirst Affiliated Hospital of Nanchang University and The People's Hospital in Jiangxi Province,and were set as the case group,and 88 patients non-PJP were selected as the control group according to the transplantation time of 22 PJP patients after renal transplantation(before and after 1 month)at a ratio of 1:4.By chi-square test,two independent sample t-test,binary logestic regression analysis,to research the effect of relevant variable on the incidence of pneumocystis jirovecii pneumonia(PJP)after renal transplantation.The clinical data of PJP patients were analyzed,including risk factors of absolute lymphocyte count,HDL,plasma level of 1,3-dod-glucan,mechanical ventilation,application of human albumin,immunoglobulin.To investigate the risk factors of renal transplant recipients and the clinical data of patients with PJP.Results:In univariate analysis,duration of preventive use of sulfadine(PJP group,1.36±2.57;non-PJP group,4.94±1.70),hemodialysis time(20±19.104 in PJP group,1.9±6.51,),preoperative dialysis(45.5% in PJP group,81.8% in non-PJP group),history of hypertension(63.6% in the PJP group,22.7% in the non-PJP group),history of previous CMV virus infection(45.5% in the PJP group,1.1% in the non-PJP group),and serum CMV virus antibody(63.6% in the positive PJP group,26% in the non-PJP group)were significantly different(P<0.05).Duration of preventive use of sulfonamide(P=0.001)and history of CMV virus infection(P=0.008)were independent risk factors for PJP in multivariate analysis.Conclusions:In this study,the related risk factors of PJP were the duration of preventive use of sulfonamide,preoperative abdominal dialysis,hemodialysis time,preoperative dialysis method,history of hypertension,previous CMV virus infection,serum CMV virus antibody detection.The independent risk factors is the duration of prevention use of sulfonamide and history of CMV virus infection.Previous history of cytomegalovirus infection,And high valence of serum CMV-IgM and CMV-IgG were risk factors for PJP infection,suggesting prolonged duration of prophylactic use of sulfa drugs.PJP patients after kidney transplantation look forward to the multidisciplinary collaborative diagnosis and treatment platform centered on the transplantation department to make joint diagnosis and treatment,so as to minimize the economic burden of patients,drug toxicity and side effects and symptoms.