Chest
Clinical InvestigationsPNEUMONIAThe Diagnosis of Pneumonia in Renal Transplant Recipients Using Invasive and Noninvasive Procedures
Section snippets
Patients
All 565 renal transplant recipients (transplants received between March 1984 and August 2001) at Taichung Veterans General Hospital, a teaching hospital and tertiary referral center at Taichung, Taiwan, were surveyed. We retroactively studied all episodes of fever, cough, and new pulmonary infiltrates in these patients from the beginning of transplantation to the day of graft failure or patient mortality. All of the patients received prophylactic antibiotics with trimethoprim-sulfamethoxazole
Results
Of the 565 patients (330 men and 235 women; mean age, 40.0 ± 11.7 years [mean ± SD]), 92 patients had episodes of pneumonia (58 men and 34 women; mean age, 42.2 ± 13.6 years). The median follow-up period of these 565 patients was 81.0 ± 46.1 months (range, 1 to 209 months). Initially, 106 patients had pulmonary infiltrates; of these, 14 patients were excluded due to acute pulmonary edema combining with other infections (n = 12) and diffuse pulmonary hemorrhage (n = 2). In the remaining 92
Discussion
The choice of a diagnostic procedure in immunocompromised patients must be based on the yield for the most likely pathogens and the safety of the procedure. Sputum should be obtained from renal transplant patients with pneumonia because it is easily done, although BAL or biopsy provides a more accurate means of diagnosis. Open lung biopsy (OLB) is considered the “gold standard” for evaluation of lung infiltrates in the immunocompromised host. In the report by White et al,6 OLB in patients with
ACKNOWLEDGMENT
We thank Dr. Michael S. Niederman for the review of this manuscript.
References (39)
- et al.
Pulmonary infiltrates in immunocompromised patients: diagnostic value of telescoping plugged catheter and bronchoalveolar lavage
Chest
(1989) - et al.
New approaches in the diagnosis of nosocomial pneumonia
Med Clin North Am
(1994) - et al.
Etiology and microbial patterns of pulmonary infiltrates in patients with orthotopic liver transplantation
Chest
(2000) - et al.
Utility of bronchoalveolar lavage in assessing pneumonia in immunosuppressed renal transplant recipients
Am J Med
(1993) - et al.
Pneumonia in the compromised host including cancer patients and transplant patients
Infect Dis Clin North Am
(1998) - et al.
The continuing utility of bronchoalveolar lavage to diagnose opportunistic infection in AIDS patients
Am J Med
(1994) - et al.
Pulmonary cytomegalovirus infection in immunocompromised patients
Chest
(2001) - et al.
Rapid diagnosis of cytomegalovirus pneumonia in marrow transplant recipients by bronchoalveolar lavage using the polymerase chain reaction, virus culture, and the direct immunostaining of alveolar cells
Blood
(1993) Infectious disease complications of renal transplantation
Kidney Int
(1993)- et al.
Randomised trial of efficacy and safety of oral ganciclovir in the prevention of cytomegalovirus disease in liver-transplant recipients: The Oral Ganciclovir International Transplantation Study Group
Lancet
(1997)
Strategies to improve long-term outcomes after renal transplantation
N Engl J Med
The lung in the immunocompromised patient: infectious complications; part 1
Respiration
The lung in the immunocompromised patient: infectious complications; part 2
Respiration
Quantitative cultures of endotracheal aspirates for the diagnosis of ventilator-associated pneumonia
Am Rev Respir Dis
The utility of open lung biopsy in patients with hematologic malignancies
Am J Respir Crit Care Med
Open-lung biopsy in the renal transplant recipient
Surgery
Diagnosis of pneumonitis in immunocompromised patients by open lung biopsy
Cancer
Use of bronchoscopy in the diagnosis of infection in the immunocompromised host
Thorax
Bronchoalveolar lavage for diagnosing acute bacterial pneumonia
J Infect Dis
Cited by (65)
Evaluation of the Renal Transplant Recipient in the Emergency Department
2019, Emergency Medicine Clinics of North AmericaIs hospital-acquired pneumonia different in transplant recipients?
2019, Clinical Microbiology and InfectionCitation Excerpt :In this line, the data available from the RESITRA study showed an overall mortality of 46.3% in allo-HSCT, with 66% of these deaths considered to be related to pneumonia [17]. The reported mortality rates of nosocomial pneumonia in SOT recipients have been as high as 50–70% [30,43–46]. In PT recipients mortality varies from 14% to 40% depending on whether HAP or VAP is considered [25,47].
Utility of fiber-optic bronchoscopy in pulmonary infections among abdominal solid-organ transplant patients: A comprehensive review
2019, Respiratory MedicineCitation Excerpt :However, the relative risk of pneumonia was noted to be lower within 6–12 months versus after 6–12 months of renal transplantation [2.97 (95% confidence interval [CI], 1.13–7.28) and 3.62 (95% CI, 1.22–9.84)] in a study by Chang et al. The same study showed that bacterial (21 of 92 patients) and mixed-bacterial (10 of 92 patients) infections were the most common etiologies of pneumonia with Staphylococcus aureus, Streptococcus pneumonia, and gram-negative bacilli as the leading microbes, respectively [1]. Several studies have documented the utility of FOB in diagnosis of bacterial pneumonia among aSOT patients.
Infectious Complications Following Solid Organ Transplantation
2019, Critical Care ClinicsCitation Excerpt :Perioperative antibiotics, which are focused on preoperative cultures from the recipient and donor, reduce the incidence of early bacterial pneumonia to less than 10%.20,21 Regarding cardiac, hepatic, and renal transplants, the incidence of early bacterial pneumonia is 15%, 9%, and 4% to 6%, respectively,18–20,26,27 with a mortality of 21% to 35% in liver and kidney transplant recipients. However, mortality between nosocomial and community-acquired infection was extreme at 58% compared with 8%20–22 with mechanical ventilation and nosocomial infections at a higher increased risk for death.18,20–22,24