[Analysis of eleven cases of severe pneumonia in kidney transplant recipients].
OBJECTIVE
To analyse retrospectively the diagnosis and treatment of severe pneumonia in kidney transplantation recipients.


METHODS
Between January 1999 and December 2003, 172 adult patients underwent kidney transplantation at our department. In all severe pneumonia cases, empirical therapy was initiated with aztreonam, erythromycin and ganciclovir. And the therapy was switched to proper antibiotics according to the results of sensitivity testing. Responsible pathogen was detected by study of BAL (bronco-alveolar-lavage), sputum and blood specimen. Analyses included cell differential count, cytopathologic examination and cultures for bacteria, fungi and viruses. The immunosuppressive therapy was drastically reduced. Hypoxia was relieved by BiPAP (Bi-level Positive Airway Pressure) or mechanical ventilation if necessary.


RESULTS
Seventeen cases (9.9%) of pneumonia were observed in the 172 recipients, only 11 (65%) patients experienced severe pneumonia, 1 (9%) of them died. Fever was the most common symptom on presentation (82%). On presentation 46% of the patients presented with classical clinical syndrome of fever accompanied by cough and dyspnea. Positive rate of BAL and blood culture were 100% and 46% respectively. BiPAP and mechanical ventilation were required in 6 and 2 cases respectively.


CONCLUSIONS
BAL is preferred for early detection of responsible pathogen. A combination of drastic reduction of the immunosuppressive regimen, implementation of appropriate empirical antibiotics, proper BiPAP or mechanical ventilation are important.
Xu
Tao
T
Department of Urology, Peking University People's Hospital, Beijing 100044, China. tx-bj@vip.sina.com
Wang
Xiao-feng
XF
Dong
Xiao-song
XS
Qu
Xing-ke
XK
Ye
Hai-yun
HY
Huang
Xiao-bo
XB
Han
Fang
F
Hou
Shu-kun
SK
D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D014184:Transplantation, Homologous / Q000009:adverse effects