Yeşiler Fatma İrem, Yazar Çagla, Şahintürk Helin, Zeyneloğlu Pınar, Haberal Mehmet
From the Department of Anesthesiology and Critical Care Unit, Baskent University Faculty of Medicine, Ankara, Turkey.
Exp Clin Transplant. 2022 Jan;20(1):83-90. doi: 10.6002/ect.2021.0215. Epub 2021 Jul 16.
Pneumonia is a significant cause of morbidity and mortality in solid-organ transplant recipients. We studied the demographic characteristics, respiratory management, and outcomes of solid-organ transplant recipients with pneumonia in an intensive care unit.
There have been 2857 kidney, 687 liver, and 142 heart transplants performed between October 16, 1985, and February 28, 2021, at our center. We retrospectively analyzed records for 51 of 193 recipients with pneumonia during the posttransplant period between January 1, 2016, and December 31, 2018.
Fifty-one of 193 recipients were followed in the intensive care unit. Mean age was 45.4 ± 16.6 years among 42 male (82.4%) and 9 female (17.6%) recipients. Twenty-six patients (51%) underwent kidney transplant, 14 (27.5%) liver transplant, 7 (13.7%) heart transplant, and 4 (7.8%) combined kidney and liver transplant. Most pneumonia episodes occurred 6 months after transplant (70.6%) with acute hypoxemic respiratory failure. Mean Acute Physiology and Chronic Health Evaluation System II score was 18.9 ± 7.7, and the Sequential Organ Failure Assessment score was 8.5 ± 3.9 at intensive care unit admission. Whereas 66.7% of pneumonia cases were nosocomial acquired, 33.3% were community acquired. The intensive care unit and 28-day mortality rates were 39.2% and 64.7%, respectively.
Solid-organ transplant recipients with pneumonia have been associated with poor prognosis. Our cohort followed in the intensive care unit comprised mostly patients with nosocomial pneumonia with acute hypoxemic respiratory failure, hospitalized 6 months after transplant with high Acute Physiology and Chronic Health Evaluation System II scores predictive of mortality. In this high-risk patient group, careful follow-up, early discovery of warning signs, and rapid treatment initiation could improve the outcomes in the intensive care unit.
肺炎是实体器官移植受者发病和死亡的重要原因。我们研究了重症监护病房中实体器官移植受者肺炎的人口统计学特征、呼吸管理及预后情况。
1985年10月16日至2021年2月28日期间，我们中心共进行了2857例肾移植、687例肝移植和142例心脏移植。我们回顾性分析了193例移植后肺炎受者中51例的记录，这些受者在2016年1月1日至2018年12月31日的移植后期间发病。
193例受者中的51例在重症监护病房接受随访。42例男性（82.4%）和9例女性（17.6%）受者的平均年龄为45.4±16.6岁。26例患者（51%）接受了肾移植，14例（27.5%）接受了肝移植，7例（13.7%）接受了心脏移植，4例（7.8%）接受了肾肝联合移植。大多数肺炎发作发生在移植后6个月（70.6%），伴有急性低氧性呼吸衰竭。重症监护病房入院时，急性生理与慢性健康状况评分系统II的平均评分为18.9±7.7，序贯器官衰竭评估评分为8.5±3.9。66.7%的肺炎病例为医院获得性，33.3%为社区获得性。重症监护病房死亡率和28天死亡率分别为39.2%和64.7%。
实体器官移植受者肺炎的预后较差。我们在重症监护病房随访的队列主要包括医院获得性肺炎伴急性低氧性呼吸衰竭的患者，这些患者在移植后6个月住院，急性生理与慢性健康状况评分系统II评分高，提示预后不良。在这个高危患者群体中，仔细随访、早期发现警示信号并迅速开始治疗可改善重症监护病房的预后。
