title: Early- and late-onset severe pneumonia after renal transplantation.
abstract: BACKGROUND
  The aim of this study was to clarify the distinctions in the clinical characteristics and outcomes between early- and late-onset severe pneumonia after renal transplantation requiring ICU admission.
  
  
  METHODS
  The data were retrospectively collected in consecutive renal recipients with severe pneumonia from January 1, 2009, to December 31, 2013, in a tertiary ICU. We classified the patients according to the time of pneumonia onset as follows: early-onset severe pneumonia (E-SP) corresponded to a pulmonary infection occurring during the first year following the transplantation, and late-onset severe pneumonia (L-SP) corresponded to a pulmonary infection occurring after the first year following the transplantation.
  
  
  RESULTS
  In the E-SP patients, fungi (42.1%) and viruses (31.6%) were the most common pathogens. Twenty-three (71.9%) patients received non-invasive ventilation (NIV), 15 (65.2%) of whom were intubated. The median duration of the ICU and hospital stays was 11 ± 5 and 19 ± 4 days, respectively. In the L-SP patients, bacteria (42.1%) and viruses (26.3%) were the predominant pathogens. Four of 15 (26.7%) patients failed NIV treatment. The median duration of the ICU and hospital stays was 9 ± 3 and 16 ± 3 days, respectively. The ICU mortality among the E-SP patients was 18.8% (6 of 32), compared with 7.1% (2 of 28) in the L-SP group (P = 0.264).
  
  
  CONCLUSIONS
  Early-onset severe pneumonia in renal transplant recipients resulted in a more serious condition, higher rate of NIV failure, longer duration of mechanical ventilation, and increased length of ICU and hospital stays.
authors.affiliation: Department of Critical Care Medicine, Zhongshan Hospital, Fudan University Shanghai, P. R. China.
authors.forename: Guowei
authors.initials: G
authors.lastname: Tu
authors.affiliation: Department of Critical Care Medicine, Zhongshan Hospital, Fudan University Shanghai, P. R. China.
authors.forename: Minjie
authors.initials: M
authors.lastname: Ju
authors.affiliation: Department of Critical Care Medicine, Zhongshan Hospital, Fudan University Shanghai, P. R. China.
authors.forename: Yijun
authors.initials: Y
authors.lastname: Zheng
authors.affiliation: Department of Urology, Zhongshan Hospital, Fudan University Shanghai, P. R. China.
authors.forename: Ming
authors.initials: M
authors.lastname: Xu
authors.affiliation: Department of Urology, Zhongshan Hospital, Fudan University Shanghai, P. R. China.
authors.forename: Ruiming
authors.initials: R
authors.lastname: Rong
authors.affiliation: Department of Critical Care Medicine, Zhongshan Hospital, Fudan University Shanghai, P. R. China.
authors.forename: Duming
authors.initials: D
authors.lastname: Zhu
authors.affiliation: Department of Urology, Zhongshan Hospital, Fudan University Shanghai, P. R. China.
authors.forename: Tongyu
authors.initials: T
authors.lastname: Zhu
authors.affiliation: Department of Critical Care Medicine, Zhongshan Hospital, Fudan University Shanghai, P. R. China.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Luo
keywords: Renal transplantation; mechanical ventilation; non-invasive ventilation; severe pneumonia