Berkman N, Glazer M, Friedlaender M M, Rubinger D, Lafair J S, Breuer R, Kramer M R
Institute of Pulmonology, Hadassah University Hospital, Jerusalem, Israel.
Isr J Med Sci. 1997 Mar;33(3):164-9.
Over the past few years, we have observed a substantial increase in the number of patients followed at our hospital who have undergone renal transplantation from living unrelated donors (LURD). These transplants were all performed in one of two centers: Bagdad, Iraq or Bombay, India. We have observed a parallel increase in the number of cases of Pneumocystis carinii pneumonia (PCP) post-renal transplant. We conducted a ten-year retrospective analysis (1986-1995) of patients who developed PCP post-renal transplant to determine the risk factors associated with the development of this infection, with particular reference to the type of transplant and the center in which the transplant was performed. Over this period, 270 renal transplant patients were followed at this hospital and 10 episodes of PCP were documented (3.7%). Six of these cases occurred within the last 2 years, as compared to only 4 cases in the preceding 8 years. All of the cases observed in the last 2 years occurred in patients who had undergone renal transplantation from LURD in Iraq or in India. During the same period, we observed no cases of PCP in patients who had undergone transplantation in Israel (cadaver or related living donor transplants). We could find no difference between patients undergoing transplant from LURD and those undergoing other transplants in terms of immuno-suppressive therapy, frequency of organ rejection episodes or coexistent CMV infection. All patients were of Arab descent and live in the West Bank. Although we cannot identify any obvious explanation for this association, we believe that these cases represent a true cluster phenomenon. We therefore feel it is warranted for all recipients of renal transplants from living unrelated donors seen in our hospital to receive prophylactic therapy for Pneumocystis carinii pneumonia.
在过去几年里，我们注意到我院随访的接受非亲属活体供肾移植（LURD）的患者数量大幅增加。这些移植手术均在两个中心之一进行：伊拉克的巴格达或印度的孟买。我们还观察到肾移植后卡氏肺孢子虫肺炎（PCP）病例数也相应增加。我们对1986年至1995年肾移植后发生PCP的患者进行了为期十年的回顾性分析，以确定与这种感染发生相关的危险因素，特别涉及移植类型和进行移植的中心。在此期间，本院共随访了270例肾移植患者，记录到10例PCP病例（3.7%）。其中6例发生在过去2年，而前8年仅有4例。过去2年观察到的所有病例均发生在接受伊拉克或印度非亲属活体供肾移植的患者中。同一时期，我们在以色列接受移植的患者（尸体或亲属活体供肾移植）中未观察到PCP病例。在免疫抑制治疗、器官排斥反应发作频率或合并巨细胞病毒感染方面，我们未发现接受非亲属活体供肾移植的患者与接受其他移植的患者之间存在差异。所有患者均为阿拉伯血统，居住在约旦河西岸。尽管我们无法确定这种关联的任何明显解释，但我们认为这些病例代表了一种真正的聚集现象。因此，我们认为我院所有接受非亲属活体供肾移植的患者都有必要接受卡氏肺孢子虫肺炎的预防性治疗。
