Study on the diagnosis and treatment of severe pneumonia following renal transplantation in the elderly
10.3760/cma.j.issn.0254-9026.2009.07.012
- VernacularTitle:老年人肾移植术后重症肺炎的特点及诊治
- Author:
Rong MA
;
Yong WANG
;
Xiaobei LI
- Publication Type:Journal Article
- Keywords:
Kidey,transplantation;
Pneumonia
- From:
Chinese Journal of Geriatrics
2009;28(7):563-566
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the key points of the diagnosis and treatment of severe pneumonia following renal transplantation in the elderly. Methods The clinical data of 28 patients with severe pneumonia following renal transplantation were retrospectively analyzed, including 20 cases aged <60 years (<60 years old group) and 8 cases aged ≥60 years (≥60 years old group). Results In <60 years old group, the severe pneumonia occurred during 1-13 months after the renal transplantation. All the patients had fever. 10 cases coughed and 8 cases had expectoration. 6 cases had type I respiratory failure (RF) and 3 cases experienced type 11 RF. 6 cases had lobar pneumonia and 13 cases occurred interstitial pneumonia. One case experienced lung consolidation. The pathogens of 16 cases in <60 years old group were identified, including 4 cases with bacterial pneumonia, 4 cases with cytomegalovirus (CMV) pneumonia, 2 cases with pneumocystis carinii pneumonia, Ⅰ case with mycoplasma infection, Ⅰ case with tuberculosis infection, and 4 cases with mixed infection (2 cases infected by bacteria plus CMV, 1 case by bacteria plus fungi and 1 case by bacteria plus tuberculosis). Combined drugs (broad-spectrum antibiotic, antivirus and antifungal agent) were administered on the initial stage and sensitive drugs were used later according to the pathogens. Hormone or immunoglobulin was used when other drugs were useless. 17 cases were cured and 3 cases died. In ≥60 years old group, the severe pneumonia occurred during 1-9 months after renal transplantation. All 8 patients had fever, too. 5 cases coughed and 3 cases had expectoration. 3 cases experienced type ⅠRF and 1 case experienced type Ⅱ RF. 3 cases had lobar pneumonia and 5 casesoccurred interstitial pneumonia. The pathogens of 5 eases were identified. Among them, 2 cases were affected by bacterial pneumonia, 1 case by CMV pneumonia and 2 cases by mixed pneumonia (one by bacteria plus CMV, one by bacteria plus fungi). Similar modality was applied, and 5 cases were cured and 3 cases died. Conclusions Most of severe pneumonia occur during 1-9 months after renal transplantation in the elderly. The main pathogens are bacteria and CMV. Medications for all of the most common pathogens and assisted ventilation should be used early. Specific narrow-spectrum antibiotic or antiviral drugs could be used quickly after pathogens were identified, and hormone or immunoglobulin could be administered to patients when the infection is severe or the pathogens are uncertain.
