Clinical characteristics and survival analysis of post-renal transplantation pneumonia_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LIU Xiaoshu , ZHOU Juan , XIE Zhengliang , GUO Lu ,  YANG Yang

Department of Respiratory Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, Sichuan 610072, P.R.China;

Corresponding author：

YANG Yang, Email: 18981838300@189.com

Keywords：

Renal transplantation; Pneumonia; Infection; Survival analysis

DOI：

10.7507/1671-6205.201609006

Video：

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ObjectiveTo analyze the clinical characteristics and related prognostic factors of post-renal transplantation pneumonia.MethodsThe clinical data of 89 patients with post-renal transplantation pneumonia in Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital from 1st January 2014 to 31st December 2015 were collected in the study. Kaplan-Meier method was used to calculate overall survival. Cox analysis was used to analyze the related prognostic factors.ResultsPost-renal transplantation pneumonia occurred mainly within 6 months after renal transplantation. The prominent clinical manifestations were cough (95.5%), fever (56.1%), and dyspnea (12.3%). The mortality of post-renal transplantation pneumonia was 11.2% and all death occurred within 5 months after transplantation. The overall survival rate significantly decreased in the patients with C-reactive protein (CRP) ≥40 mg/L (P<0.001), procalcitonin ≥1 ng/ml (P=0.002), brain natriuretic peptide >100 pg/ml (P<0.001), platelet ≤100×10⁹/L (P<0.001), or those with occurrence time of pneumonia <180 days (P=0.013). Platelet ≤100×10⁹/L could increase the risk of death by 66.6 times (RR=0.015, P=0.006), and CRP ≥ 40 mg/L could increase the risk of death by 20 times (RR=0.05, P=0.029).ConclusionsPost-renal transplantation pneumonia has prominent clinical characteristics. Platelet ≤100×10⁹/L or CRP ≥40 mg/L can increase the risk of death and can be used as an independent prognoctic factor of post-renal transplatation pneumonia.

Citation： LIU Xiaoshu, ZHOU Juan, XIE Zhengliang, GUO Lu, YANG Yang. Clinical characteristics and survival analysis of post-renal transplantation pneumonia. Chinese Journal of Respiratory and Critical Care Medicine, 2017, 16(4): 327-331. doi: 10.7507/1671-6205.201609006 Copy

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3.	Miller BW, Brennan DC, Korenblat PE, et al. Common variable immunodeficiency in a renal transplant patient with severe recurrent bacterial infection: a case report and review of the literature. Am J Kidney Dis, 1995, 25(6): 947-951.
4.	Passalacqua JA, Wiland AM, Fink JC, et al. Increased incidence of postoperative infections associated with peritoneal dialysis in renal transplant recipients. Transplantation, 1999, 68(4): 535-940.
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7.	Ducloux D, Courivaud C, Bamoulid J, et al. Prolonged CD4 T cell lymphopenia increases morbidity and mortality after renal transplantation. J Am Soc Nephrol, 2010, 21(5): 868-875.
8.	Schurmann M, Schurmann D, Schindler R, et al. Impaired thymic function and CD4+ T lymphopenia, but not mannose-binding lectin deficiency, are risk factors for Pneumocystis jirovecii pneumonia in kidney transplant recipients. Transpl Immunol, 2013, 28(4): 159-163.
9.	Tu GW, Ju MJ, Han Y, et al. Moderate-dose glucocorticoids as salvage therapy for severe pneumonia in renal transplant recipients: a single-center feasibility study. Ren Fail, 2014, 36(2): 202-209.
10.	Dupont PJ, Manuel O, Pascual M. Infection and chronic allograft dysfunction. Kidney Int Suppl, 2010, (119): S47-53.
11.	Dizdar OS, Ersoy A, Akalin H. Pneumonia after kidney transplant: incidence, risk factors, and mortality. Exp Clin Transplant, 2014, 12(3): 205-211.
12.	Chalmers JD, Singanayagam A, Hill AT. C-reactive protein is an independent predictor of severity in community-acquired pneumonia. Am J Med, 2008, 121(3): 219-225.
13.	Boussekey N, Leroy O, Alfandari S, et al. Procalcitonin kinetics in the prognosis of severe community-acquired pneumonia. Intensive Care Med, 2006, 32(3): 469-472.
14.	Menendez R, Martinez R, Reyes S, et al. Stability in community-acquired pneumonia: one step forward with markers?. Thorax, 2009, 64(11): 987-992.
15.	Menendez R, Cavalcanti M, Reyes S, et al. Markers of treatment failure in hospitalised community acquired pneumonia. Thorax, 2008, 63(5): 447-452.
16.	Bozza FA, Shah AM, Weyrich AS, et al. Amicus or adversary: platelets in lung biology, acute injury, and inflammation. Am J Respir Cell Mol Biol, 2009, 40(2): 123-134.
17.	Thiery-Antier N, Binquet C, Vinault S, et al. Is thrombocytopenia an early prognostic marker in septic shock?. Crit Care Med, 2016, 44(4): 764-772.
18.	Mueller C, Scholer A, Laule-Kilian K, et al. Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea. N Engl J Med, 2004, 350(7): 647-654.
19.	Hopkins WE, Chen Z, Fukagawa NK, et al. Increased atrial and brain natriuretic peptides in adults with cyanotic congenital heart disease: enhanced understanding of the relationship between hypoxia and natriuretic peptide secretion. Circulation, 2004, 109(23): 2872-2877.
20.	Shor R, Rozenman Y, Bolshinsky A, et al. BNP in septic patients without systolic myocardial dysfunction. Eur J Intern Med, 2006, 17(8): 536-540.
21.	Li J, Ye H, Zhao L. B-type natriuretic peptide in predicting the severity of community-acquired pneumonia. World J Emerg Med, 2015, 6(2): 131-136.

1. 中华医学会呼吸病学分会. 社区获得性肺炎诊断和治疗指南. 中华结核和呼吸杂志, 2006, 29(10): 651-655.
2. American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med, 2005, 171(4): 388-416.
3. Miller BW, Brennan DC, Korenblat PE, et al. Common variable immunodeficiency in a renal transplant patient with severe recurrent bacterial infection: a case report and review of the literature. Am J Kidney Dis, 1995, 25(6): 947-951.
4. Passalacqua JA, Wiland AM, Fink JC, et al. Increased incidence of postoperative infections associated with peritoneal dialysis in renal transplant recipients. Transplantation, 1999, 68(4): 535-940.
5. Fishman JA, Rubin RH. Infection in organ-transplant recipients. N Engl J Med, 1998, 338(24): 1741-1751.
6. Rubin RH. Infectious disease complications of renal transplantation. Kidney Int, 1993, 44(1): 221-236.
7. Ducloux D, Courivaud C, Bamoulid J, et al. Prolonged CD4 T cell lymphopenia increases morbidity and mortality after renal transplantation. J Am Soc Nephrol, 2010, 21(5): 868-875.
8. Schurmann M, Schurmann D, Schindler R, et al. Impaired thymic function and CD4+ T lymphopenia, but not mannose-binding lectin deficiency, are risk factors for Pneumocystis jirovecii pneumonia in kidney transplant recipients. Transpl Immunol, 2013, 28(4): 159-163.
9. Tu GW, Ju MJ, Han Y, et al. Moderate-dose glucocorticoids as salvage therapy for severe pneumonia in renal transplant recipients: a single-center feasibility study. Ren Fail, 2014, 36(2): 202-209.
10. Dupont PJ, Manuel O, Pascual M. Infection and chronic allograft dysfunction. Kidney Int Suppl, 2010, (119): S47-53.
11. Dizdar OS, Ersoy A, Akalin H. Pneumonia after kidney transplant: incidence, risk factors, and mortality. Exp Clin Transplant, 2014, 12(3): 205-211.
12. Chalmers JD, Singanayagam A, Hill AT. C-reactive protein is an independent predictor of severity in community-acquired pneumonia. Am J Med, 2008, 121(3): 219-225.
13. Boussekey N, Leroy O, Alfandari S, et al. Procalcitonin kinetics in the prognosis of severe community-acquired pneumonia. Intensive Care Med, 2006, 32(3): 469-472.
14. Menendez R, Martinez R, Reyes S, et al. Stability in community-acquired pneumonia: one step forward with markers?. Thorax, 2009, 64(11): 987-992.
15. Menendez R, Cavalcanti M, Reyes S, et al. Markers of treatment failure in hospitalised community acquired pneumonia. Thorax, 2008, 63(5): 447-452.
16. Bozza FA, Shah AM, Weyrich AS, et al. Amicus or adversary: platelets in lung biology, acute injury, and inflammation. Am J Respir Cell Mol Biol, 2009, 40(2): 123-134.
17. Thiery-Antier N, Binquet C, Vinault S, et al. Is thrombocytopenia an early prognostic marker in septic shock?. Crit Care Med, 2016, 44(4): 764-772.
18. Mueller C, Scholer A, Laule-Kilian K, et al. Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea. N Engl J Med, 2004, 350(7): 647-654.
19. Hopkins WE, Chen Z, Fukagawa NK, et al. Increased atrial and brain natriuretic peptides in adults with cyanotic congenital heart disease: enhanced understanding of the relationship between hypoxia and natriuretic peptide secretion. Circulation, 2004, 109(23): 2872-2877.
20. Shor R, Rozenman Y, Bolshinsky A, et al. BNP in septic patients without systolic myocardial dysfunction. Eur J Intern Med, 2006, 17(8): 536-540.
21. Li J, Ye H, Zhao L. B-type natriuretic peptide in predicting the severity of community-acquired pneumonia. World J Emerg Med, 2015, 6(2): 131-136.

Chinese Journal of Respiratory and Critical Care Medicine

Clinical characteristics and survival analysis of post-renal transplantation pneumonia

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