title: An aggressive systematic strategy for acute respiratory distress syndrome caused by severe pneumonia after renal transplantation.
abstract: Acute respiratory distress syndrome (ARDS) caused by pneumonia after renal transplantation was usually associated with overimmunosuppression and high mortality rate. We evaluated the efficacy of an aggressive systemic protocol including strategies improving body's immune function. Twenty-one recipients were enrolled in this study. Patients were subjected to a protocol including (i) withdrawal of most immunosuppressants, (ii) early use of immunoenhancers and continuous renal replacement therapy (CRRT), (iii) reasonable administration of antibiotic regimen, (iv) prompt mechanical ventilating strategy, and (v) adequate nutrition. Immunosuppressants were adjusted according to the value of CD4+, CD8+T lymphocytes in peripheral blood. CRRT was conducted at once when patients were admitted to the intensive care unit (ICU), regardless the graft function. Thirteen (62%) survived and eight died finally. This is a high survival rate for this kind of patients. Eighteen patients had received thymosin treatment. All patients who survived experienced renal allograft dysfunction during CRRT, but when CRRT stopped, the function of all grafts gradually recovered. No acute rejection episodes were documented during the treatment. The aggressive systemic protocol including strategies improving the body's immune function and CRRT can improve the outcome of patients with ARDS after renal transplantation. The count of CD4+, CD8+T lymphocytes of peripheral blood is useful in the adjustment of immunosuppressants and the prediction of patient outcome.
authors.affiliation: Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China. sunqiquan@yahoo.com
authors.forename: Qiquan
authors.initials: Q
authors.lastname: Sun
authors.forename: Zhi-Hong
authors.initials: ZH
authors.lastname: Liu
authors.forename: Jinsong
authors.initials: J
authors.lastname: Chen
authors.forename: Shuming
authors.initials: S
authors.lastname: Ji
authors.forename: Zheng
authors.initials: Z
authors.lastname: Tang
authors.forename: Zhen
authors.initials: Z
authors.lastname: Cheng
authors.forename: Daxi
authors.initials: D
authors.lastname: Ji
authors.forename: Lei-Shi
authors.initials: LS
authors.lastname: Li
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D018529:Nutritional Support; D011014:Pneumonia / Q000150:complications* / Q000209:etiology; D017582:Renal Replacement Therapy; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000276:immunology / Q000628:therapy*; D013601:T-Lymphocytes / Q000276:immunology
chemical_list: D000276:Adjuvants, Immunologic; D000890:Anti-Infective Agents