Clinical Analysis Of 44 Cases Severe Pulmonary Infection After Renal Transplantation

With the development of organ transplantation, renal transplant has becomea well-established therapeutic option for end-stage renal function failure. Thepatient must administrate immunosuppressant for long-term in order to preventthe rejection of the graft and also maintain normal renal function, their immunedefense ability are weaken seriously. Moreover nearly all of them hasexperienced uremia, dialysis for long time, anemia and hypoproteinemia arepresent, thus the power of resistance is feeble, They are invaded by pathogenicmicroorganism easily. The lung is the organ which is the most easily infectedowing to particular anatomy. Unfortunately, pulmonary infection is one of themost causes of morbidity and mortality in kidney allograft recipients. Althoughwith the application of new drugs such as antibiotics, antimycin, antivirus and soon. In particular the doctors have accumulated much experience, the incidencerate of respiratory infection after renal transplantation has decreaseddramatically. But it is still double than the general population, it is also the maincomplication and the cause of death. According to literature the incidence rate ofinfection after kidney transplant is up to 13%-70%. Severe pulmonary infectioncan lead to the death of patients, even which can result in rejection and thefailure of renal transplant. Base on statistics, among the case of death afterkidney transplant, respiratory infection of which accounting for 70% or so,about 59% was revived. This article carries out multi-analysis from happen timeof pulmonary infection, clinic characteristic, imageology appearance, diagnosisof pathogen, therapeutic measure and curative effect. So that raise therecognition of disease and the capacity of diagnosis and treatment.The clinic data of 44 inpatients with pulmonary infection after kidneytransplant were collected, and their happen time of pulmonary infection, cliniccharacteristic, imageology appearance, diagnosis of pathogen, therapeuticmeasure and curative effect were analyzed in detail.The data indicates that infection was highest during the first three monthsand from three to six months following transplantation, account for 38.64 % and27.27 % respectively, especially the first 6 months, account for 81.82%。The clinical manifestation in respiratory infection after kidney transplantare nonspecific, some patients might have no symptoms, but others can havefever, accounting for 81.82%, their mean temperature is 38.63±0.64 oC . In ourdata, Fever, breathlessness after activity, and cough are the common symptoms,accounting for 81.82 %,65.91 %,54.55 % respectively, there are 9 inpatientswho have classic presentations of fever, breathlessness after activity, and cough,accounting for 20.45 %. Respiratory sound attenuation is the main sign,accounting for 72.73 %。Therefore, there is a variable clinical manifestation .The symptoms are not uniform to signs, and the disease develops very quickly,even deteriorate to ARDS within 3-10 days.The occurrence of abnormal X ray of chest is later than the common people,In early period the chest imageology is probably normal, accounting for 36.36%。With the disease developed, the diffused hyalinization become the mostcommon manifestation, accounting for 72.73 %, the lower is patchinghigh-density shadow, accounting for 63.64 %。The imageology of diseasedevelops from the normal to consolidation of lung only needs 3-10 days, so it isvery fast.Among the infections, the common pathogenic bacteria is gram stainnegative bacillus. The culture of sputum and blood is limited to find pathogenicbacteria. When the non invasive means can not identify the causative organism,BAL should be done as routine,so as to elevate the detective rate。De-escalation therapy (DET) is different to the traditional concept ofescalation, It is an adequate initial therapy that should be applied to thenosocomial pneumonia, especially for sever pneumonia in ICU and ventilationassociated pneumonia. And it is an empirical anti-infection therapy. Includestwo procedure: the first one is to choose broad-spectrum and powerfulantibiotics as initial empirical therapy, according to possible pathogenic bacteriaand antibiotic sensitivity. Once the patients were suspected of infection, themanagement should be carried out immediately, and cover all malignant bacteriaas possible. The second is to adjust the antibiotics based on the microbiologicalexamination and the pharmacal sensitivity after 48-72 hours. Once themicroorganisms were identified, the narrow-spectrum antibiotics should beapplied. The clinic data show that the DET is better than the conventionaltherapy, it can raise the appropriate rate of initial treatment, moreover shortendays in hospital. The antibiotics will not endanger the renal function oftransplant. In addition, it is necessary that reduce the dosage ofimmunosuppressive drug or stop using, supportive and symptomatic treatmentare the key points of successful treatment. Recently, NPPV has been applied inclinical practice of respiratory failure widespread, it can rectify hypoxia in somedegree, and for some people can be exempted intubations. It is important toimprove prognosis and lower mortality.