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RENAL TRANSPLANTS HASTALARDA PNEUMOCYSTIS CARÎNÎÎ PNÖMONÎSÎ

PNEUMOCYSTIS CARIMI PNEUMONIA IN RENAL TRANSPLANT PATIENTS

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 1999

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Pneumocystis carinii pneumonia (PCP) is an opportunistic infection, which results in increased morbidity and mortality during the posttransplant period. In our study we retrospectively analyzed 713 patients, who were followed up at the Transplantation Out-Patient Clinic of Istanbul School of Medicine during 1983 -1998; among whom 9 (% 0.13) were complicated with PCP (7 male, 2 female, mean age: 36.1 years). Four of them got their kidneys from cadaveric and five from living donors. Three patients had acute rejection. As maintenance immunosuppression, 2 patients had double and others had triple therapy. Patients were complicated with PCP on average 4.5 (3 - 8) months posttransplant. During the infection their mean serum creatinin level was 1.6 (1.3-1.7) mg/dl.. Pneumocystis carinii pneumonia was diagnosed by bronchoscopy and the pathological and immunofluorescent antibody examination of bronchoalveolar lavage material. Four patients also had cytomegalovirus infection. Trimethoprim at a dose of 20 mg/dl was administered in the combination form as co-trimoxazole, parenterally to one patient and orally to the others. Three patients died; while all the others survived with preserved graft functions. Pneumocystis carinii pneumonia should always be suspected in renal transplant patients presenting with sudden onset respiratory distress and cough and invasive techniques should be instituted early to initiate the appropriate therapy.
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Abstract (Original Language): 
Pneumocystis carinii pnömonisi (PCP) posttransplant dönemde önemli bir morbidite ve mortalite nedeni olan bir enfeksiyondur. 1983-1998 yıllarında İstanbul Tıp Fakültesi Transplantasyon Polikliniğinde takip edilen 713 hastadan, PCP gelişen 9 (% 0.13) hasta (7erkek, 2 kadın, yaş ortalaması: 36.1 + 11.2) retrospektif olarak incelenmiştir Dördü kadavra ve 5i canlı donörden böbrek almıştı. Üç hastamızda akut rejeksiyon öyküsü vardı. İdame immünosüpressif tedavi olarak sadece 2 hasta (%22) Siklosporin A ve Prednizolon kullanırken, diğerleri (%78) Siklosporin A, Azathiopürin ve Prednizolon kullanmakta idi. Posttransplant dönemde ortalama 4.5 ay sonra PCP gelişti. İnfeksiyon sırasında serum kreatinin düzeyleri ortalama 1.6 mg/dl bulundu. Pneumocystis carinii pnömonisi, tanısı bronkoskopik ve bronkoalveolar lavaj materyalinin patolojik ve immüntflor esans incelenmeleri ile konuldu. Dört hastada birlikte sitomegalovirüs enfeksiyonu saptandı. Sekiz hastaya oral ve Vine parenteral 20 mg/kg/gün trimetoprim dozunda kotrimoksazol tedavisi 21 gün uygulandı. Toplam 3 hasta hayatını kaybetti. Renal transplantlı hastalarda ani gelişen solunum sıkıntısı ve balgam çıkarma öyküsü, fırsatçı enfeksiyonlardan PCP'yi akla getirmelidir. Erken tanı hayat kurtarıcı olduğundan, invazif işlemler hızla yapılarak uygun tedavi başlanmalıdır.
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  • 1
36-39
  • Turkish

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