Renal Transplant Unit, Department of Nephrology, Division of Internal Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Nephrol Dial Transplant. 2011 Oct;26(10):3391-8. doi: 10.1093/ndt/gfr048. Epub 2011 Mar 8.
Pneumocystis jiroveci pneumonia (PCP) is an important cause of morbidity and mortality in renal transplant recipients (RTRs). Chemoprophylaxis with trimethoprim/sulphamethoxazole is recommended during the early post-transplantation period, but the optimal duration has not been determined and a main drawback of chemoprophylaxis is the development of resistance of the commensal faecal flora. A cluster outbreak of PCP occurred in our outpatient Renal Transplant Unit. We aimed to investigate risk factors for PCP in RTRs to determine who should receive long-term chemoprophylaxis.
In a case-control study, we investigated common demographic variables and immunological parameters. Nine PCP cases diagnosed between August 2006 and April 2007 were matched with 18 control patients, who did not develop PCP, received their transplant in the same time-period and had a similar follow-up period with a comparable immunosuppressive drug regimen.
The median time from transplantation to PCP was 19 months. We observed no significant differences in gender, age, donor type or number of rejections. In PCP cases, the median lymphocyte count just before PCP diagnosis was 0.49 (0.26-0.68), which was significantly reduced compared to the control patients after a similar follow-up period (median 1.36, 0.59-3.04, P = 0.002). This lymphocytopaenia was chronic and existed in most patients already for many months. CD4(+) T-cell counts were also significantly reduced in the PCP cases. We found no difference in the Th1, Th2 and Th17 subsets between PCP cases and control patients.
Long-term prophylactic therapy for PCP may be indicated for RTR with persistent severe lymphocytopaenia.
卡氏肺孢子虫肺炎（PCP）是肾移植受者（RTR）发病率和死亡率的重要原因。建议在移植后早期使用复方磺胺甲噁唑进行化学预防，但尚未确定最佳持续时间，化学预防的一个主要缺点是共生粪便菌群产生耐药性。我们的门诊肾移植科发生了一起卡氏肺孢子虫肺炎的聚集性暴发。我们旨在调查 RTR 中卡氏肺孢子虫肺炎的危险因素，以确定谁应该接受长期化学预防。
在一项病例对照研究中，我们调查了常见的人口统计学变量和免疫参数。2006 年 8 月至 2007 年 4 月诊断的 9 例卡氏肺孢子虫肺炎病例与 18 例未发生卡氏肺孢子虫肺炎的对照患者相匹配，这些对照患者在同一时期接受移植，具有相似的随访期和类似的免疫抑制药物方案。
从移植到卡氏肺孢子虫肺炎的中位时间为 19 个月。我们观察到性别、年龄、供体类型或排斥反应次数无显著差异。在卡氏肺孢子虫肺炎病例中，卡氏肺孢子虫肺炎诊断前的中位淋巴细胞计数为 0.49（0.26-0.68），与随访期相似的对照患者相比明显降低（中位数 1.36，0.59-3.04，P = 0.002）。这种淋巴细胞减少症是慢性的，在大多数患者中已经存在了好几个月。卡氏肺孢子虫肺炎病例的 CD4+ T 细胞计数也明显降低。我们发现卡氏肺孢子虫肺炎病例和对照患者之间 Th1、Th2 和 Th17 亚群没有差异。
对于持续严重淋巴细胞减少症的 RTR，可能需要长期预防性治疗卡氏肺孢子虫肺炎。
