Risk Factors And Prognostic Factors Of Severe Pneumocystis Jirovecii Pneumonia In Renal Transplant Recipients

Objective After renal transplantation,patients need long-term use of immunosuppressive drugs to induce immune tolerance,and the incidence of Pneumocystis jirovecii pneumonia is high.This study retrospectively analyzed the clinical data of severe PCP patients and non-severe PCP patients,and explored the early risk factors for PCP patients to develop into severe PCP,as well as the risk factors for poor prognosis in severe PCP patients,so as to identify severe PCP patients early and target them in a timely manner.Strengthen the treatment measures to improve the clinical cure rate of PCP.Long-term follow-up of patients was conducted to analyze the effect of PCP on the long-term survival of kidney transplant recipients and transplanted kidneys.MethodsThe clinical data of 78 patients with PCP after renal transplantation diagnosed and treated in Anhui Provincial Hospital from June 1,2010 to December 31,2020 were retrospectively collected,and the demographic data,laboratory test results,treatment plan and clinical conversion of the patients were analyzed.Return.On the basis of the severity of PCP,we have two groups,including severe PCP group and non-severe PCP group,and then using Logistic regression to discuss the clinical factors.According to the different clinical prognosis of patients,the severely PCP were separated into improved PCP group and death PCP group,and then logistic regression analysis was applied to analyze the clinical factors in connection with death patients.Further analysis of receiver operating curve（ROC）for each independent risk factor.Long-term follow-up of the cured and discharged patients was carried out,and the Kaplan-Meier method was used to analyze the influence of PCP on the prognosis and function of kidney transplantation recipients.Results1.A total of 78 patients with PCP after kidney transplantation were included in this study.They were divided into groups according to the severity of the disease,including43 cases in the non-severe group and 35 cases in the severe group.Univariate analysis of risk factors associated with severe PCP included use of triple immunosuppressive regimen containing tacrolimus after kidney transplantation（P=0.019）,comorbid bacterial infection（P=0.007）,and high neutrophil ratio/count（P=0.007）.=0.002),low lymphocyte ratio/count（P<0.001）,high CRP level（P<0.001）,high PCT level（P<0.001）,low albumin level（P<0.001）,high creatinine level（P= 0.015）.Multivariate Logistic analysis showed that the independent risk factors for the severity of PCP patients after kidney transplantation were postoperative use of triple immunosuppressive regimen including tacrolimus（P=0.009）and low lymphocyte ratio/count（P=0.047）)and high CRP levels（P=0.013）.Further ROC curve analysis found that when the lymphocyte count was 0.49×109/L or the CRP value was 56.30 mg/L,it was the best critical value for predicting severe PCP.2.A total of 8 patients died,all of which occurred in the severe PCP group.Further prognostic analysis of severe PCP patients was performed.In univariate analysis,the risk factors associated with poor prognosis PCP included bacterial infection（P=0.006）,high CRP level（P=0.004）,and low calcium ion concentration（P=0.028）.Multivariate Logistic analysis found that bacterial infection（P=0.022）and high CRP level（P=0.039）were independent risk factors for the prognosis of severe PCP patients.The ROC curve analysis of the above risk factors found that the CRP value of 74.42 mg/L was the best critical value for predicting poor prognosis in severe PCP patients.3.Kaplan-Meier survival analysis showed that the survival rates of PCP patients in the first and fifth years after kidney transplantation were 88.60% and 82.90%,respectively;the survival rates of the first and fifth years after kidney transplantation were 92.10%and 64.80%,respectively.Conclusions1.When kidney transplant recipients with PCP use the triple immunosuppressive regimen containing tacrolimus,and the lymphocyte count is lower than 0.49x109/L and the CRP value is higher than 56.30 mg/L,they should be alert to develop severe PCP.When PCP patients are combined with bacterial infections and the CRP value is higher than 74.42 mg/L,poor prognosis may occur,and intensive treatment measures should be given as soon as possible to improve the clinical cure rate.2.The progression of PCP after kidney transplantation is related to the immune status and bacterial infection,and PCP will affect the long-term survival rate of kidney transplant recipients and transplanted kidneys.