| Objective: Deep fungal infection after renal transplant was rarely seen and the treatment was troublesome.This study regressively analyzed the clinical features in renal transplant patients with IPFI at our hospital,in order to elevate the diagnostic accuracy and to improve therapeutic approaches.Methods: Medical record data from allogeneic renal transplant at our hospital(2013.02-2016.02)were included in this regression analysis.By inclusion criteria,21 cases diagnosed with IPFI were defined as IPFI group;60 randomly selected cases with bacterial pneumonia or without any pulmonary infection were evenly divided into bacterial infection group and normal group.Information of age,gender,coexisting disease,AR history,immunosuppression plan,CT image manifestation,FK506 concentration,microbiological result,pathology,hospital duration,anti-fungal plan and prognosis were extracted and analyzed.Results: There were 21 cases met the inclusion criteria,including 15 male cases and 6 female cases,aging from 32 to 59 for an average age of 44.76±8.52.There were 6 cases of probable diagnosis(29%),4 cases of clinical diagnosis(19.0%)and 11 cases of definite diagnosis(52%).The incident rate was 7.42% and the mortality was 4.76%,with 20 cases of recovery.The average hospital stay was 40.6d(11~102d).Occurrence time of pulmonary fungal infection: 4 cases of within 1m(19.0%),16 cases of 2-6m(76.2%),and 1 case of more than 6m(4.76%).CT imaging diagnosis: 8 cases of interstitial diseases(38.1%),5 cases of exudative diseases(23.8%),3 cases of crescent sign(14.3%),2 cases of solid lesions(9.52%),2 cases of nodular lesions(9.52%)and 1 case of cavity lesion(4,76%).Pathogenic distribution: a total of 16 fungal strains were isolated from phlegm and BALF cultivation,including 7 Candida albicans strains(43.8%),4 Aspergillus strains(25.0%),3 Candida krusei strains(18.8%),1 Candida tropicalis strain(6.25%)and 1 Saccharomyces albicans strain(6.25%).Disease: In IPFI group,there were 6 cases of diabetes(28.6%)and 7 cases of hypertension(33.3%);in bacterial group,there were 8 cases of diabetes(26.7%)and 9 cases of hypertension(30.0%);in normal group,there were 2 cases of diabetes(6.67%)and 7 cases of hypertension(23.3%).The difference in diabetes case numbers were statistically significant(p<0.05),while no statistical significance was observed in hypertension(p>0.05).Immunosuppression maintaining plan: FK506 concentrations in IPFI group were(8.24±2.07)ng/ml two weeks before infection,(10.0±1.90)ng/ml during infection and(7.95±2.41)ng/ml after control.FK506 concentration in normal group was(8.63±2.20)ng/ml.The difference in FK506 concentrations between IPFI group during infection and normal group was statistically significant(p<0.05).Conclusions: 1.The mortality and prognosis in renal transplant patients with IPFI were unfavorable,which was worthy of additional attention;2.The Candida albicans was the most common infection in renal transplant patients with IPFI;3.The high-incidence period of infection was within 6 months after renal transplant;4.The excessive immunosuppression was an important factor in developing IPFI;5.Full dose of anti-fungal medicine in time was the key to recovery,and full treatment course of anti-fungal maintaining treatment was effective in controlling disease progression. |
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