title: Pneumonia after kidney transplant: incidence, risk factors, and mortality.
abstract: OBJECTIVE
  Pneumonia is an important cause of morbidity and mortality in recipients of solid-organ transplant. We aimed to determine risk factors for development of pneumonia and associated deaths in kidney transplant recipients.
  
  
  METHODS
  A retrospective review of medical records was performed for all kidney transplant recipients from December 1988, to April 2011. The diagnosis of community-acquired pneumonia was made from symptoms, clinical findings, and chest radiography. The diagnosis of nosocomial pneumonia was made according to published criteria. Laboratory and serologic tests, radiographic findings, cultures of respiratory specimens, and tissue biopsies were reviewed.
  
  
  RESULTS
  In 406 kidney transplant recipients, there were 82 patients (20%) who had 111 episodes of pneumonia, including 49 nosocomial episodes of pneumonia (44%). Bacterial infections were the most common cause (34 episodes [31%]). In multivariate analysis, significant risk factors associated with pneumonia episodes were older age, hypertension, cardiac disease, history of acute graft rejection, and not using everolimus/mycophenolate mofetil/prednisolone protocol. There were 28 episodes that resulted in death (25%), including 20 nosocomial episodes (71%). In multivariate analysis, significant risk factors associated with death from pneumonia episodes were antibiotic use in the previous 3 months, high C-reactive protein, and low albumin. Cutoff values for increased risk of death from pneumonia included C-reactive protein > 10 mg/dL and procalcitonin > 8.8 ng/mL.
  
  
  CONCLUSIONS
  Recipients of kidney transplant may be at risk for pneumonia and associated death. Nosocomial pulmonary infections may be associated with marked morbidity and mortality in kidney transplant recipients.
authors.affiliation: Department of Internal Medicine, Afsin State Hospital, Kahramanmaras, Turkey.
authors.forename: Oguzhan Sitki
authors.initials: OS
authors.lastname: Dizdar
authors.forename: Alparslan
authors.initials: A
authors.lastname: Ersoy
authors.forename: Halis
authors.initials: H
authors.lastname: Akalin
mesh_terms: D000328:Adult; D000367:Age Factors; D016009:Chi-Square Distribution; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D015897:Comorbidity; D003428:Cross Infection / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011014:Pneumonia / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult