Experience in diagnosis and treatment of severe pneumonitis following renal transplantation

    WANG Dong, TAN Jianª²Ming, WU Weiª²Zhen, YANG Shunª²Liang, LIN Wenª²Hong, XU Tingª²Zhao, CAI Jinª²Quan, TAO Xiaoª²Qin, YANG Xiaoª²Ling

    Department of Urology, Fuzhou General Hospital Nanjing, Military Area Commond, Fuzhou 350025, China

    ¡¾Abstract¡¿ AIM: To explore the diagnosis and treatment of severe pneumonitis following renal transplantation. METHODS: A retrospective analysis was made on the clinical data of 52 renal transplant recipients with severe pneumonitis, which were diagnosed by the clinical symptoms, chest Xª²ray and CT. The treatments included withdrawal of immunosuppressive agents, administration of empirical antiª²infective drugs and methylprednisolone, prevention and treatment of secondary infection, reinforcement of nutritional support and use of respirator if necessary. Simultaneously responsible pathogen was detected by analyses of BAL (bronchoª²alveolar lavage), sputum and blood specimen, with regard to cell differential count, cytopathologic examination and cultures for bacteria, fungi and viruses. RESULTS: Seventyª²six cases (8.7%) of pneumonia were found in the 877 renal transplant vecipients, which included 52 (68%) patients with severe pneumonia. Fever and chest distress were the most common initial symptoms of severe pneumonia (100%). However, obvious cough and expectoration were observed only in 10 patients (19%). Positive rate of BAL alone and of blood culture combined with pharynx swab and sputum were 69%(31/45) and 38%(20/52), respectively. The treatments were effective in 39 with 34 being cured and 5 being improved; 13 of 52 finally died. The effective rate was 75%. CONCLUSION: Severe pneumonitis is a most common lifeª²threatening complication in renal transplant recipient, which mostly occurs during 6 months after renal transplantation. BAL should be performed early for detection of responsible pathogen. The key points of successful treatment involve withdrawal of immunosuppressive agents, administration of empirical antiª²infective drugs and methylprednisolone. ......