Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India.
Department of Pulmonary Medicine and Sleep Disorders, New Delhi, India.
Transpl Int. 2021 Mar;34(3):525-534. doi: 10.1111/tri.13817. Epub 2021 Feb 26.
Pulmonary infection is a leading cause of morbidity and mortality in renal transplant recipients. In a prospective study, we characterized their epidemiology in a tropical country with high infectious disease burden. Adult renal transplant recipients presenting with pulmonary infections from 2015 to 2017 were evaluated using a specific diagnostic algorithm. 102 pulmonary infections occurred in 88 patients. 32.3% infections presented in the first year, 31.4% between 1 and 5, and 36.3% beyond 5 years after transplantation. Microbiological diagnosis was established in 69.6%, and 102 microorganisms were identified. Bacterial infection (29.4%) was most common followed by tuberculosis (23.5%), fungal (20.6%), Pneumocystis jiroveci (10.8%), viral (8.8%), and nocardial (6.9%) infections. Tuberculosis(TB) and bacterial infections presented throughout the post-transplant period, while Pneumocystis (72.7%), cytomegalovirus (87.5%) and nocardia (85.7%) predominantly presented after >12 months. Fungal infections had a bimodal presentation, between 2 and 6 months (33.3%) and after 12 months (66.7%). Four patients had multi-drug resistant(MDR) TB. In 16.7% cases, plain radiograph was normal and infection was diagnosed by a computed tomography imaging. Mortality due to pulmonary infections was 22.7%. On multivariate Cox regression analysis, use of ATG (HR-2.39, 95% CI: 1.20-4.78, P = 0.013), fungal infection (HR-2.14, 95% CI: 1.19-3.84, P = 0.011) and need for mechanical ventilation (9.68, 95% CI: 1.34-69.82, P = 0.024) were significant predictors of mortality in our patients. To conclude, community-acquired and endemic pulmonary infections predominate with no specific timeline and opportunistic infections usually present late. Nocardiosis and MDR-TB are emerging challenges.
肺部感染是肾移植受者发病率和死亡率的主要原因。在一项前瞻性研究中，我们在一个传染病负担高的热带国家对其进行了流行病学特征描述。2015 年至 2017 年间，出现肺部感染的成年肾移植受者采用特定的诊断算法进行评估。88 例患者共发生 102 例肺部感染。32.3%的感染发生在移植后 1 年内，31.4%发生在 1-5 年内，36.3%发生在 5 年以后。69.6%确定了微生物学诊断，共鉴定出 102 种微生物。细菌感染（29.4%）最常见，其次是结核病（23.5%）、真菌病（20.6%）、卡氏肺孢子虫肺炎（10.8%）、病毒性肺炎（8.8%）和奴卡菌病（6.9%）。结核病（TB）和细菌感染在整个移植后期间均有发生，而卡氏肺孢子虫肺炎（72.7%）、巨细胞病毒（87.5%）和奴卡菌（85.7%）主要在 12 个月以后发生。真菌感染呈双峰分布，2-6 个月（33.3%）和 12 个月以后（66.7%）。4 例患者患有耐多药结核（MDR-TB）。16.7%的患者胸片正常，通过计算机断层成像（CT）进行诊断。肺部感染导致的死亡率为 22.7%。多变量 Cox 回归分析显示，使用抗胸腺细胞球蛋白（ATG）（HR-2.39，95%CI：1.20-4.78，P=0.013）、真菌感染（HR-2.14，95%CI：1.19-3.84，P=0.011）和需要机械通气（HR-9.68，95%CI：1.34-69.82，P=0.024）是导致患者死亡的显著预测因素。总之，社区获得性和地方性肺部感染为主，没有特定的时间线，机会性感染通常发生较晚。奴卡菌病和耐多药结核（MDR-TB）是新出现的挑战。
