Management of patients with severe pulmonary infection after renal transplantation

Objective:To investigate the characteristics of occurrence,diagnosis,and treatment of severe pulmonary infection in recipients of renal transplantation.Methodology:Clinical data of renal transplant recipients who were admitted to SICU because of severe pulmonary infection from 2002 to 2010 was retrospectively reviewed.Results:A total of fifteen renal transplant recipients with severe pulmonary infection during the 8-year period.Among them,the infection occurred within 6 months in 12(80.0%),and within 3 months in 9 cases(60.0%) after renal transplantation.12 patients were diagnosed as severe pneumonia(80.0%) and 6 were diagnosed as acute respiratory distress syndrome(40.0%).According to the place of occurrence,8 cases were hospital-acquired pneumonia(53.3%),and 7 were community-acquired pneumonia(46.7%).According to the pathogenic microorganism,12 cases were bacterial pneumonia,4 cases were fungal pneumonia,and one case was pneumocystis carinii pneumonia.No pathogen was identified in 3 cases.Among 12 cases with identified pathogen,4 were mixed infection(33.3%).After combining therapy,13 patients(86.7%) were cured,while 2(13.3%) were died.Conclusion:High attention should be paid to patients with severe pulmonary infection after renal transplantation.Early pathogenic diagnosis,aggressive antibiotic therapy according to pathogenic microorganism,prompt modulation of immunosuppressive therapy,reinforced supportive therapy,and mechanical ventilation when necessary to correct hypoxia are key elements of successful management.