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Objective:To explore the clinical characteristics of pneumocystis carinii pneumonia (PCP) after kidney transplantation.Methods:From January 2020 to January 2022, clinical data were retrospectively reviewed for 13 renal transplant recipients with pneumocystis pneumonia diagnosed by metagenomics next generation sequencing (mNGS). There were 3 females and 10 males with an age range of (46±10) years.The median time of postoperative onset was 10(2-21) months; The major clinical manifestations included fever ( n=11), cough ( n=7), expectoration ( n=6) and dyspnea ( n=11). Paired t-test was employed for analyzing the laboratory results at admission and discharge. Results:The diagnosis was confirmed by the detection of NGS in alveolar lavage fluid or venous blood.The levels of G test, LDH test, total T lymphocyte absolute count (CD3+ Abs), inhibitory/cytotoxic T lymphocyte count (CD3+ CD8+ Abs) and auxiliary/induced T lymphocyte absolute count (CD3+ CD4+ Abs) were (543.27±440.49) pg/ml, (529.98±222.43)U/L and (191.92±119.42)/μl, (87.33±50.59)/μl and (106.92±87.42)/μl at admission and (69.58±50.21) pg/ml, (285.38±46.62 U/L), (888.58±672.99)/μl, (336.83±305.21)/μl and (520.08±388.76)/μl at discharge.The differences were statistically significant ( P<0.001, P=0.002, 0.006, 0.017, 0.005). All of them received compound sulfamethoxazole and caspofungin.Except for one death due to septic shock after 21-day treatment, 12 cases were cured. Conclusions:mNGS test is one of the important tool for an early diagnosis of PCP.Combined use of compound sulfamethoxazole and caspofungin is an effective anti-infective regimen.And immune function monitoring is vital for adjusting antibiotic and immunosuppressive regimens.
RESUMO
Objective:To explore the protective effect of hypothermia plus extracorporeal membrane oxygenation(ECMO)on kidney in brain-dead kidney transplant donors.Methods:From July 2017 to July 2018 at Institute of Transplantation Medicine, Hospital No. 923 of PLA, 29 patients with circulatory dysfunction brain death donors fulfilling the organ donation criteria were randomly divided into sub-hypothermia group according to the treatment of extracorporeal membrane oxygenation(body temperature 34.0~35.0℃, 15 cases)and normal temperature group(36.5~37.5℃, 14 cases). Hemodynamic profiles and renal function changes were compared between two groups during ECMO.And renal complications of two groups were followed up.Results:The hemodynamic parameters of two groups remained stable during ECMO period.Heart rate of 5 MO-organs was lower in hypothermia group than that in normal temperature group( P<0.05). Systolic and diastolic pressures before ECMO 3 h-organ acquisition were higher than normal temperature group( P<0.05). No significant difference existed between PaO 2 and normal temperature groups( P>0.05). Donor serum creatinine(SCr)and blood urea nitrogen(BUN)were lower in hypothermia group than in normal temperature group( P<0.05). The postoperative recipient levels of BUN were lower in mild hypothermia group than those in normothermia group( P<0.05)and no significant difference between SCr and normal temperature groups( P>0.05). The postoperative hospital stay was(16.52±3.59)days in mild hypothermia group. And it was lower than that in normal temperature group( P<0.05). Delayed renal function was lower than normal temperature group(3.45% and 21.43%, P<0.05). Conclusions:Mild hypothermia plus ECMO can reduce hemodynamic fluctuations in circulatory unstable donors after brain death, improve renal function and lower the incidence of delayed functional recovery after renal transplantation.