Pneumocystis Pneumonia After Renal Transplantation(Report Of 30 Cases)

ObjectivePreliminarily study medical impact factors on prognosis of Pneumocystis carinii pneumonia (PCP) after renal transplantation, and the clinical features of recipients infected with PCP after renal transplant.MethodsRetrospective analysis clinical data of 30 cases diagnosed with PCP after renal transplantation in our hospital. Recording time of treatment of sulfamethoxazole (SMZ-TMP) for PCP of each patient, the application of corticosteroid, adjustment of immunosuppressive agents, clinical symptoms and signs, laboratory tests, imaging study data, prognosis and so on. Analyze treatment time of SMZ-TMP for PCP, using glucocorticoid, adjustment of immunosuppressive agents on the prognosis of patients. Statistical analysis using SPSS 16.0 software, count data, using X2 test, P<0.05 as statistically significant difference.ResultComparing the effect of the application of SMZ-TMP for PCP after renal transplantation in 15 days to the application of treatment of the drug in more than 15 days, the former effective rate is 94.73%, the other is 63.63%, the two is tested by X2 test, P<0.05, there is statistically significant difference; Of 20 patients using glucocorticoid,3 cases PO2>70 mmHg, the other PO2≤70 mmHg, of which 6 cases have type I respiratory failure. In 10 cases without glucocorticoid,1 case PO2<70 mmHg, the other PO2>70 mmHg. All patients after immunosuppression reduction during hospitalization, no significant change in renal function, no acute rejection; this group of 30 patients with PCP after renal transplantation,24 cases (80.00%) occurred in the first six months after transplantation,3 cases (10.00%) complicated ARDS by the use of mechanical ventilation,25 cases (83.33%) cured,5 cases with cytomegalovirus (CMV); there is a transient rise in serum creatinin levels of 10 patients, after stoping using SMZ-TMP and adjustment of immunosuppressants, that returns to the level prior to the onset. After 1 to 2 months,30 patients take lung CT, the shadow of all lungs disappear.ConclusionTreatment with SMZ-TMP for renal transplant patients with PCP as soon as possible could improve the cure rate; PO2≤70mmHg, simultaneously using glucocorticoid could reduce interstitial lung disease; readuction of immunosuppressant in time could prevent harm to patients by excessive of inhibition.