Pneumocystis pneumonia (PCP) incidence was decreased in renal transplant thanks to prophylaxis, recommended during the first months after transplantation. However, many late PCP cases are observed after the first 6 months and recommendations to maintain or reintroduce prophylaxis are lacking. The objective of the study was to identify risk factors to guide the individual prescription of prophylaxis, 6 months after transplantation. Thirty-three late PCP cases were identified between 1995 and 2012 in Lille Hospital, France, and were compared to 72 randomized controls transplant recipients. In univariate analysis, age of donor (>48 years), retransplantation, a decrease glomerular filtration rate (≤45 mL/min), induction therapy mediated by anti-thymocyte globulin (ATG), steroid maintenance, high calcineurin inhibitors (CNI) doses (tacrolimus ≥0.5 mg/kg/day and cyclosporine ≥2.1 mg/kg/day), and cytomegalovirus (CMV) infection were significantly associated with PCP. In multivariate analysis, ATG (hazard ratio [HR]: 2.4 [1.1-5.4]), steroid therapy (HR: 3.1 [1.20-7.84], CNI (HR: 2.9 [1.28-6.38], and CMV (HR: 6.1 [2.74-16.33] remained associated with late PCP. In conclusion, we confirm that intensive immunosuppressive regimen and CMV infection are critical risk factors for late PCP and should be taken into account to decide on maintenance or reintroduction of a prophylactic treatment.

译文

由于预防,建议在移植后的头几个月内,肾移植的肺孢子虫肺炎 (PCP) 发病率降低。然而,在最初的6个月后观察到许多晚期PCP病例,并且缺乏维持或重新引入预防的建议。该研究的目的是确定风险因素,以指导移植后6个月的预防处方。在法国里尔医院1995年发现了33例晚期PCP病例,并将其与72例随机对照移植受者进行了比较。在单因素分析中,供体年龄 (>48岁),再移植,降低肾小球滤过率 (≤ 45 ml/min),抗胸腺细胞球蛋白 (ATG) 介导的诱导治疗,类固醇维持,高钙调磷酸酶抑制剂 (CNI) 剂量 (他克莫司 ≥ 0.5 mg/kg/天和环孢素 ≥ 2.1 mg/kg/天) 和巨细胞病毒 (CMV) 感染与PCP显着相关。在多变量分析中,ATG (危险比 [HR]: 2.4 [1.1-5.4]),类固醇治疗 (HR: 3.1 [1.20-7.84],CNI (HR: 2.9 [1.28-6.38]) 和CMV (HR: 6.1 [2.74-16.33] 仍然与晚期PCP相关。总之,我们确认强化免疫抑制方案和CMV感染是晚期PCP的关键危险因素,应考虑维持或重新引入预防性治疗。

+1
+2
100研值 100研值 ¥99课程
检索文献一次
下载文献一次

去下载>

成功解锁2个技能,为你点赞

《SCI写作十大必备语法》
解决你的SCI语法难题!

技能熟练度+1

视频课《玩转文献检索》
让你成为检索达人!

恭喜完成新手挑战

手机微信扫一扫,添加好友领取

免费领《Endnote文献管理工具+教程》

微信扫码, 免费领取

手机登录

获取验证码
登录