Abstract:

BACKGROUND: The immunity of patients can be obviously suppressed since a large amount of immunosuppressor is used in the early stage after kidney transplantation, therefore pneumocystis carinii pneumonia (PCP) tends to have a high incidence during this period.
OBJECTIVE: To explore the clinical features, diagnosis, treatment, and prevention of PCP after kidney transplantation.
METHODS: Twelve cases complicated with PCP were collected from 378 cases of kidney transplantation patients from the Nephrology Department of the First People’s Hospital of Foshan from November 2000 to July 2010. And then the time of onsets, predisposing factors, diagnostic methods, clinical manifestations, therapeutic schedule and prophylactic efficiency were retrospectively analyzed.
RESULTS AND CONCLUSION: The time of onsets was 5.3 (3-11) months after kidney transplantation. Twelve cases of patients presented with polypnea and cyanosis with a high fever of 38.0-40.2 ℃. Nine cases experienced slight cough. Five cases coughed with a small amount of white sputum and one case with red frothy sputum. Five cases were complicated with bacterial infection, two with fungal infection, two with cytomegalovirus infection and one with tuberculosis. The infection rate was 7.8% (7/89) in patients administrated with Tacrolimus, while1.7% (5/289) in those administrated with cyclosporine A. Ventilators were applied in nine cases and two cases were treated with bi-level positive airway pressure (BIPAP) for assisted respiration. Eight cases fully recovered. However, two cases died of cerebral hemorrhage due to thrombocytopenia during the treatment, one case died of fungal infection and one case died of hemopneumothorax. No exclusive reaction was found during the treatment. These indicated that the key to raising the curative rate of PCP was early diagnosis, drug combination and decreased immunosuppressor dosage.