Department of Ultrasound Medicine, The Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Mycoses. 2021 May;64(5):495-502. doi: 10.1111/myc.13235. Epub 2021 Jan 7.
Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection among solid organ transplantation. The occurrence of PJP is dangerous and fatal if there is no early identification and sufficient treatment.
The aim of this study was to evaluate the risk factors and provide appropriate strategies of prophylaxis and treatment for PJP after kidney transplantation in our centre.
PATIENTS/METHODS: From January 2009 to December 2018, a total of 167 kidney transplantation recipients with pneumonia were enrolled, including 47 PJP patients as PJP group and 120 non-PJP patients as control group. The clinical characteristics of the two groups were analysed retrospectively.
Multivariate analysis showed that high total dosage of ATG [OR, 2.03; 95% CI, 1.12-3.68] and cytomegalovirus (CMV) infection were independent risk factors for PJP. Trimethoprim-sulfamethoxazole (TMP-SMX) (1.44 g q6h)-based treatment was used for 2 weeks, and its dosage and course were adjusted according to the therapeutic effect and side effects. Forty-five cases were recovered after 3 months of follow-up, and two patients died of respiratory failure. TMP-SMX (0.48 g/day) prophylaxis was used for 3-6 months and prolonged to 7-8 months after treatment for acute rejection, which reduced the incidence of PJP compared with those without prophylaxis.
Our study suggests that the high total dosage of ATG and CMV infection indicate the increased risk of PJP. The strategies of prophylaxis and treatment for PJP after kidney transplantation in our centre were effective.
卡氏肺孢子菌肺炎（PJP）是实体器官移植后的机会性感染。如果不能早期识别和充分治疗，PJP 的发生是危险和致命的。
本研究旨在评估本中心肾移植后 PJP 的危险因素，并为其提供合适的预防和治疗策略。
患者/方法：2009 年 1 月至 2018 年 12 月，共纳入 167 例肺炎肾移植受者，其中 47 例为 PJP 患者（PJP 组），120 例为非 PJP 患者（对照组）。回顾性分析两组患者的临床特征。
多因素分析显示，总 ATG 剂量高[比值比（OR），2.03；95%可信区间（CI），1.12-3.68]和巨细胞病毒（CMV）感染是 PJP 的独立危险因素。采用复方磺胺甲噁唑（TMP-SMX）（1.44 g，q6h）治疗 2 周，根据治疗效果和不良反应调整剂量和疗程。45 例患者在 3 个月的随访中痊愈，2 例患者因呼吸衰竭死亡。TMP-SMX（0.48 g/天）预防治疗 3-6 个月，在急性排斥反应治疗后延长至 7-8 个月，与未预防组相比，降低了 PJP 的发生率。
本研究表明，总 ATG 剂量高和 CMV 感染提示 PJP 风险增加。本中心肾移植后 PJP 的预防和治疗策略有效。
