KL GUPTA1, S BAGAI2, A SHARMA1
1PGIMER, Chandigarh, India, Chandigarh, India, 2Max Superspeciality hospital, Saket, Delhi, India
Background: Lung is one of the most frequently involved organ in transplant patients and the incidence of is around 2.9-30%.
Aims: To study the risk factors, clinical profile, treatment and outcomes of post renal transplant pneumonia.
Methods: Transplant recipients from November 2014 to June 2017 who had pneumonia were included.
Results: Hundred out of 550 transplant recipients developed pneumonia. Mean age of patients was 39.63 years and the mean duration at diagnosis post transplantation was 39.48 months. Fever (87%), cough (80%), breathlessness (63%), hypotension (31%) and hemoptysis (10%) were common presentations. Mean serum creatinine at admission was 1.80 mg/dl. Pulmonary tuberculosis was the most common etiology 33(33%) followed by bacterial pneumonia 15(15%), Pnemocystis jeroveki 13(13%), Cytomegalo virus (CMV) 12(12%), Aspergillosis 10(10%, Mucormycosis 9(9%), Cryptococcosis 4(4%), Nocardiosis 3(3%), pheohypomycosis 2 (2%) and histoplasosis 1 (1%). Twenty patients (20%) had dual infection.
Transbronchial lung biopsy 24(24%), computed tomography guided fine needle aspiration 20(20%), bronchoalveolar lavage 13(13%) and trans Bronchial lymph node aspiration 2(2%) helped in diagnosis. Culture positivity rate was 22%. Thirteen patients (13%) patients were empirically treated. The risk factors identified in these patients were use of Anti-thymocyte Globulin 35(35% ), post transplant diabetes mellitus 19 (19%), CMV 19 (19%), rejection 9 (22.5%), HCV infection 5 (12.5%) and HBV infection 1 (2.5%).
Outcome: On follow up clinical improvement occurred in 79(79%) patients and 21 (21%) had expired amongst which 6 (28%) deaths were due to mucormycosis.
Conclusion: Post transplant pneumonias are serious opportunistic infection in post renal transplant patients in India. A high index of suspicion helps in early diagnosis and prompt treatment.
Dr K L Gupta is Professor of Nephrology and Head of Department at The prestigious Postgraduate Institute of Medical Education and Research at Chandigarh India. He has been serving as the faculty member since 1983. His Mai areas of interest include Fungal Infections following Renal translation as well as angio-invasive Fungal Infections of the native kidneys and Lupus Nephritis. He has been awarded many fellowship including FASN, FRCP (London) , FAMS, FISOT, FISN etc. He is currently the President of the Indian Society of Organ Transplantation and President of the Nephrology, Urology and Transplantation Society of SAARC Countries.