Reichenberger F, Dickenmann M, Binet I, Solèr M, Bolliger C, Steiger J, Brunner F, Thiel G, Tamm M
Department of Internal Medicine, University Hospital, Basel, Switzerland.
Transpl Infect Dis. 2001 Mar;3(1):2-7. doi: 10.1034/j.1399-3062.2001.003001002.x.
Organ transplant recipients are at high risk of infectious pulmonary complications. In this retrospective study, the diagnostic yield of bronchoalveolar lavage (BAL) was evaluated in renal transplant recipients. The results were analysed in special regard to the clinical presentation of pulmonary infections and the possible impact of new immunosuppressive agents. Over a 5-year period 91 BAL were performed in 71 renal transplant recipients. Microorganisms were isolated from 69% of BAL (63/91): bacteria 32%; cytomegalovirus (CMV) 27%; Pneumocystis carinii (PC) 22%; other viruses 9% (HSV; EBV, RSV, adenovirus, HHV8); Aspergillus fumigatus 1%. Total cell counts and neutrophil counts in BAL were significantly elevated in bacterial infection, whereas BAL positive for PC showed eosinophilia (P<0.05). There was no association between clinical symptoms and the radiological pattern of infiltrates and the type of infection. Immunosuppression containing tacrolimus or mycophenolate mofetil was associated with a significantly higher percentage of PC and CMV infections compared to cyclosporin-based immunosuppression (65% vs. 30%, P<0.005). A considerable number of PC and CMV infections occurred beyond 6 months after transplantation. In conclusion, BAL has a high diagnostic yield in renal transplant recipients. Infection with CMV and PC should also be considered beyond 6 months after transplantation, and prophylaxis for opportunistic infections should be given if the immunosuppression is intensified.
器官移植受者发生感染性肺部并发症的风险很高。在这项回顾性研究中，对肾移植受者支气管肺泡灌洗（BAL）的诊断价值进行了评估。针对肺部感染的临床表现以及新型免疫抑制剂可能产生的影响对结果进行了分析。在5年期间，对71例肾移植受者进行了91次BAL检查。69%（63/91）的BAL检查分离出微生物：细菌32%；巨细胞病毒（CMV）27%；卡氏肺孢子虫（PC）22%；其他病毒9%（单纯疱疹病毒、EB病毒、呼吸道合胞病毒、腺病毒、人类疱疹病毒8型）；烟曲霉1%。细菌感染时BAL中的总细胞计数和中性粒细胞计数显著升高，而PC阳性的BAL显示嗜酸性粒细胞增多（P<0.05）。临床症状、浸润的放射学表现与感染类型之间无关联。与基于环孢素的免疫抑制相比，含他克莫司或霉酚酸酯的免疫抑制与PC和CMV感染的比例显著更高相关（65%对30%，P<0.005）。相当数量的PC和CMV感染发生在移植后6个月之后。总之，BAL在肾移植受者中具有较高的诊断价值。移植后6个月之后也应考虑CMV和PC感染，并且如果强化免疫抑制，应给予机会性感染的预防措施。
