Clinical Characteristics of Pneumocystis Pneumonia After Parental Renal Transplantation.

Abstract

PurposeTo analyze the clinical characteristics of Pneumocystis pneumonia (PCP) in renal transplant recipients, identify early sensitivity indicators, and optimize clinical strategies.Patients and MethodsWe retrospectively analyzed clinical data for 24 patients with confirmed PCP who underwent renal transplantation (RT) between 2010 and 2019, encompassing a mean follow-up of 29 (range, 11–49) d.ResultsA 71% incidence was observed for PCP during the first 6 months after RT. Progressive dyspnea (79%) was the most common symptom, followed by fever (75%) and dry cough (67%). In the initial phase of PCP, the most frequent computerized tomography (CT) finding was the presence of symmetric, apically distributed ground-glass opacities. Nine of 11 patients (82%) were diagnosed by induced sputum testing, 14 of 17 (82%) by bronchoalveolar lavage, and 1 of 24 (4%) by sputum smear. The 1,3-β-D-glucan level was elevated (mean, 259.16 ± 392.34 pg/mL) in 80% of patients, while 75% had elevated C-reactive protein levels (median, 37.85 mg/L). Two of 18 patients (11%) were positive for cytomegalovirus. All patients were treated with trimethoprim-sulfamethoxazole (3 doses of 1–6 g/kg) and third-generation cephalosporin or moxifloxacin monotherapy to prevent bacterial infection. The methylprednisolone dose (40–400 mg/d) varied according to illness. Most patients were treated using a nasal cannula or oxygen mask, and 2 by mechanical ventilation. CT showed improved lesions after treatment, and completely absorbed lesions or residual fibrosis at follow-up. The mean hospitalization cost was 14,644.73 ± 11,101.59 RMB.ConclusionPeak PCP incidence occurred during the first 6 months after surgery. Progressive dyspnea, fever, and dry cough are important indicators for PCP. Bilateral and diffuse ground-glass opacities involving both lung apexes are often the first indication for PCP diagnosis. Induced sputum testing may be the method-of-choice for pathogen detection. The cure rate can be improved through early antipathogen, glucocorticoid, and preventive anti-infection therapies, as well as respiratory support.