Clinical analysis of pneumocystis pneumonia after kidney transplantation: a report of 13 cases
10.3760/cma.j.cn2022-0507-00103
- VernacularTitle:肾移植术后肺孢子菌肺炎13例临床分析
- Author:
Ning WEN
1
;
Jihua WU
;
Dandan ZHU
;
Rong MA
;
Jiacheng ZHOU
;
Haibin LI
;
Jianhui DONG
;
Liugen LAN
;
Zhiying LEI
;
Xuyong SUN
Author Information
1. 广西医科大学第二附属医院移植医学中心，广西器官捐献与移植研究重点实验室，广西移植医学工程技术研究中心，南宁 530007
- Keywords:
Kidney transplantation;
Pneumocystis carinii pneumonia;
Next-generation sequencing
- From:
Chinese Journal of Organ Transplantation
2022;43(5):303-308
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinical characteristics of pneumocystis carinii pneumonia (PCP) after kidney transplantation.Methods:From January 2020 to January 2022, clinical data were retrospectively reviewed for 13 renal transplant recipients with pneumocystis pneumonia diagnosed by metagenomics next generation sequencing (mNGS). There were 3 females and 10 males with an age range of (46±10) years.The median time of postoperative onset was 10(2-21) months; The major clinical manifestations included fever ( n=11), cough ( n=7), expectoration ( n=6) and dyspnea ( n=11). Paired t-test was employed for analyzing the laboratory results at admission and discharge. Results:The diagnosis was confirmed by the detection of NGS in alveolar lavage fluid or venous blood.The levels of G test, LDH test, total T lymphocyte absolute count (CD3+ Abs), inhibitory/cytotoxic T lymphocyte count (CD3+ CD8+ Abs) and auxiliary/induced T lymphocyte absolute count (CD3+ CD4+ Abs) were (543.27±440.49) pg/ml, (529.98±222.43)U/L and (191.92±119.42)/μl, (87.33±50.59)/μl and (106.92±87.42)/μl at admission and (69.58±50.21) pg/ml, (285.38±46.62 U/L), (888.58±672.99)/μl, (336.83±305.21)/μl and (520.08±388.76)/μl at discharge.The differences were statistically significant ( P<0.001, P=0.002, 0.006, 0.017, 0.005). All of them received compound sulfamethoxazole and caspofungin.Except for one death due to septic shock after 21-day treatment, 12 cases were cured. Conclusions:mNGS test is one of the important tool for an early diagnosis of PCP.Combined use of compound sulfamethoxazole and caspofungin is an effective anti-infective regimen.And immune function monitoring is vital for adjusting antibiotic and immunosuppressive regimens.
