Abstract:

BACKGROUND: The incidence rate and the mortality of severe pneumonia after renal transplantation are high. So it has great significance to early diagnosis and treatment of severe pneumonia.
OBJECTIVE: To analyze the clinical characteristics, pathogenetic condition and prognosis of severe pneumonia patients after renal transplantation treated in respiratory intensive care unit, in order to improve the early diagnosis rate and cure rate.
METHODS: Twenty-eight severe pneumonia patients after renal transplantation treated in the respiratory intensive care unit of Zhengzhou People’s Hospital from January 2004 to September 2012 were investigated retrospectively, and the characteristics were summarized. The pathogenetic condition of the patients was evaluated with Acute Physiology and Chronic Health Evaluation Ⅱ and British Thoracic Society Modified Pneumonia score CURB-65, and the patients were treated appropriately.
RESULTS AND CONCLUSION: The severe pneumonia infection in 28 patients occurred at 3-8 months after renal transplantation and most of the patients received larger immunosuppressant doses. The patients complaint of tachypnea, dry cough, chest tightness and fever. The plasma albumin of the severe pneumonia patients was significantly decreased; the arterial blood gas analysis showed the hypoxemia and low hypercapnia, and the arterial oxygen saturation was gradually decreased. Chest CT showed that there was shadow secretion in the lung. Then the patients disable the immunosuppressive drugs, combined with anti-infection treatment and non-invasive ventilator, finding that 24 patients were cured, two patients were improved and two patients were dead. The liver function and renal function of patients were progression-free during treatment. Excessive immunosuppression after renal transplantation is the risk factor for severe pneumonia; great importance to the monitoring the body temperature after the event, shortness of breath and unexplained serum albumin decreasing are benefit to the early diagnosis. Decisively disable the immunosuppressive drugs combined with the broad-spectrum anti-infective drugs, methyl prednisolone and non-invasive ventilation therapy are the key to the successful treatment.