Department of Internal Medicine, College of Medicine, Transplant Research Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
Division of Nephrology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
Microbiol Immunol. 2020 May;64(5):356-365. doi: 10.1111/1348-0421.12778. Epub 2020 Feb 25.
Cytomegalovirus (CMV) infection is associated with Pneumocystis jirovecii pneumonia (PJP) in kidney transplant recipients (KTRs), but its impact on clinical severity and outcomes in KTRs with PJP is unknown. We reviewed 1994 medical records of KTRs from January 1997 to March 2019. PJP or CMV infection was diagnosed by polymerase chain reaction or culturing using blood or respiratory specimens. We divided patients into PJP and PJP+CMV groups, and evaluated the clinical severity and outcomes. Fifty two patients had PJP (2.6%) in the whole study cohort. Among patients with PJP, 38 (73.1%) had PJP alone and 14 (26.9%) had combined PJP and CMV co-infection. The PJP+CMV group showed worse laboratory findings (serum albumin and C-reactive protein, P = 0.010 for both) and higher requirement of continuous renal replacement therapy than the PJP group (P = 0.050). The pneumonia severity was worse in the PJP+CMV group than in the PJP group (P < 0.05), and CMV infection was a high risk factor of pneumonia severity (odds ratio 16.0; P = 0.002). The graft function was worse in the PJP+CMV group (P < 0.001), and the incidence of graft failure was higher in the PJP+CMV group than in the PJP group (85.7% vs 36.8%; P < 0.001). Mortality was double in the PJP+CMV group than in the PJP group, but not statistically significant (21.4% vs 10.5%; P = 0.370). Our results show that approximately one in four patients with PJP after kidney transplantation develops CMV with increased clinical severity and risk of graft failure. The possibility of increased clinical severity and worse clinical outcomes by CMV co-infection should be considered in KTRs with PJP.
巨细胞病毒（CMV）感染与肾移植受者（KTR）中的卡氏肺孢子菌肺炎（PJP）有关，但 CMV 感染对 KTR 中 PJP 的临床严重程度和结局的影响尚不清楚。我们回顾了 1997 年 1 月至 2019 年 3 月间 1994 例 KTR 的病历。通过聚合酶链反应或血液或呼吸道标本培养诊断 PJP 或 CMV 感染。我们将患者分为 PJP 组和 PJP+CMV 组，并评估了临床严重程度和结局。整个研究队列中，52 例患者患有 PJP（2.6%）。在患有 PJP 的患者中，38 例（73.1%）为单纯 PJP，14 例（26.9%）为 PJP 合并 CMV 合并感染。PJP+CMV 组的实验室检查结果更差（血清白蛋白和 C 反应蛋白，两者均为 P<0.010），需要持续肾脏替代治疗的比例也高于 PJP 组（P=0.050）。PJP+CMV 组的肺炎严重程度较 PJP 组更严重（P<0.05），CMV 感染是肺炎严重程度的高危因素（比值比 16.0；P=0.002）。PJP+CMV 组的移植物功能更差（P<0.001），PJP+CMV 组的移植物失功发生率高于 PJP 组（85.7% vs 36.8%；P<0.001）。PJP+CMV 组的死亡率是 PJP 组的两倍，但无统计学意义（21.4% vs 10.5%；P=0.370）。我们的结果表明，肾移植后约四分之一的 PJP 患者会发生 CMV，其临床严重程度和移植物失功风险增加。CMV 合并感染可能会增加 KTR 中 PJP 的临床严重程度和临床结局恶化的可能性。
