Division of Nephrology and Immunology, Rheinisch-Westfälische Technische Hochschule Aachen, Germany.
Nephrol Dial Transplant. 2011 Jun;26(6):2013-7. doi: 10.1093/ndt/gfq689. Epub 2010 Nov 11.
Pneumocystis jiroveci pneumonia (PcP) is a potentially life-threatening complication in renal transplant recipients with increased reports during the past few years. Individual risk factors for susceptibility to PcP are incompletely understood.
We retrospectively analysed 60 cases of confirmed PcP, diagnosed in six German transplant centres between 2004 and 2008, as well as 60 matched controls.
Compared with controls, PcP cases revealed the following significant differences: PcP cases had a poorer renal function (eGFR 31 vs. 42 mL/min in controls), more biopsy-proven rejections (18 vs. 5 patients), more frequent treatment with mycophenolate mofetil (53 vs. 44 patients) and less frequent treatment with interleukin-2 receptor antagonist (20 vs. 32 patients). According to centre policy, in those years, none of the patients or controls had received PcP prophylaxis after transplantation. Of the 60 patients with PcP, 30% developed the disease after the currently recommended duration of prophylactic treatment, 27% died in the course of the disease and 45% required treatment in the ICU.
Our case-control study reveals a novel risk profile for PcP. Renal transplant recipients with more pronounced renal insufficiency following rejection episodes and treated with intensified immunosuppression are at particular risk for PcP.
肺孢子菌肺炎（PcP）是肾移植受者的一种潜在危及生命的并发症，近年来报告病例有所增加。个体易患 PcP 的风险因素尚不完全清楚。
我们回顾性分析了 2004 年至 2008 年间德国六家移植中心确诊的 60 例确诊 PcP 病例，以及 60 例匹配对照。
与对照组相比，PcP 病例有以下显著差异：PcP 病例肾功能较差（eGFR 31 与对照组的 42 mL/min）、活检证实的排斥反应更多（18 例与 5 例）、更频繁地使用吗替麦考酚酯（53 例与 44 例）和较少使用白细胞介素-2 受体拮抗剂（20 例与 32 例）。根据中心政策，在那些年，没有患者或对照接受 PcP 预防治疗。在 60 例 PcP 患者中，30%的患者在目前推荐的预防治疗持续时间后出现疾病，27%的患者在疾病过程中死亡，45%的患者需要在 ICU 治疗。
我们的病例对照研究揭示了 PcP 的一种新的风险特征。有排斥反应且接受强化免疫抑制治疗后肾功能明显不全的肾移植受者，PcP 风险特别高。
