Retrospective Analysis Of Interstitial Pneumonia In Renal Transplant Recipients (104Cases)

Objective: Explore the occurrence, prophylaxis, treatment principles ofinterstitial pneumonia in renal transplant recipients and the relationship withinduction therapy.Methods: To retrospectively analyse the104kidney transplant recipientsfrom2008to2012in the Urinary Diseases Diagnosis&Treatment Center，FirstHospital of Jilin University, who were diagnosed with interstitial pneumonia.Based on the differences on the treatment and prevention, the patients weredivided into two groups: the2008group, which include the patients fromJanuary-December，2008and the2009-2012group, which consist of thepatients from January2009-December2012. To compare the differences oftreatment, prophylaxis and the occurrence of interstitial pneumonia between thetwo groups.Results: From January2008to December2008，The number of the patientsunderwent renal transplantation is140, and the number of the renal recipientsdeveloped interstitial pneumonia is40, and the incidence rate was28.57%. FromJanuary2009to December2012, the number of the patients underwent renaltransplantation is585, and the number of the kidney recipients developedinterstitial pneumonia is64, and the incidence rate was10.94%. The prophylaxis of the interstitial pneumonia of renal transplant recipients in group2008: Thepatients were given oral ganciclovir and trimethoprim-sulfamethoxazole(SMZ-TMP) after discharge; In2008，The number of the patients underwentrenal transplantation is140，but only47patients could apply durgs to preventthe occurrence of interstitial pneumonia according to doctors’ requirements,the proportion is33.56%.The prophylaxis of the group2009-2012: Renaltransplant recipients were given oral ganciclovir and SMZ-TMP after discharge;From2008to2012, The number of the patients underwent renal transplantationis585，462patients could apply durgs to prevent the occurrence of interstitialpneumonia according to doctors’ requirements, the proportion is78.97%.According to the Signs and symptoms and pulmonary CT of the patients, thediagnosis was definite. The treatment of the interstitial pneumonia in group2008:immunosuppressive drugs were reduced or stopped, and corticosteroid therapywith conservative amount were given, broad-spectrum antibiotics, SMZ-TMP,ganciclovir and antifungal drug were given to against the mixed infections. Thetreatment of group2009-2012: withdrew immunosuppressive drugs, high-dosecorticosteroid were be used, broad-spectrum antibiotics, SMZ-TMP, ganciclovirand antifungal drug were also given to against the mixed infections. In the group2008, a total of37cases were cured/improved，2cases were dead，1case gaveup treatment and during the treatment period,3cases happened rejectionreaction. In the group2009-2012, a total of64cases were cured/improved, zerocase died and during the treatment period,5cases happened rejection reaction. From2009to2012, a total of585patients underwent the operation of kidneytransplantation, and207recipients received induction therapy includinganti-CD25monoclonal antibody or antithymocyte globulin （ATG） beforeoperation, and the other378patients did not be given. Among64cases ofinterstitial pneumonia after renal transplantation，21cases were given inductiontherapy，while43patients received nothing of the induction therapy.Conclusions: To combine the early discontinuation of immunosuppressivedrugs, anti-HCMV with ganciclovir, anti-Pneumocystis carinii with SMZ-TMP,empirical anti-mixed infections, the use of glucocorticoids (according to theseverity) with the nutrition support therapy is vitally important measure in thetreatment of interstitial pneumonia after renal transplantation. In recent years,the time of the occurrence of the interstitial pneumonia after renaltransplantation have the trend of delay. Under the premise of giving drugs toprevent the occurrence of interstitial pneumonia after renal transplantation, thereis no relationship between the use of induction therapy and the occurrence ofinterstitial pneumonia.