Clinical Characteristics of Pneumocystis Pneumonia After Parental Renal Transplantation

Figures & data

Table 1 Demographic Characteristics, Symptoms, Auxiliary Examination, and Treatment of 24 Patients with PCP After RT

Characteristic	Values
Median age (range) – years	39 ± 7 (29–57)
Gender
Male	16/24 (67%)
Female	8/24 (33%)
Coexisting illness
Hypertension	6/24 (25%)
Diabetes	3/24 (13%)
Heart disease	2/24 (8%)
Postoperative immunosuppressant
Mycophenolate mofetil + tacrolimus + glucocorticoid	8/24 (33%)
Mycophenolate mofetil +cyclosporine + glucocorticoid	16/24 (67%)
Onset time
≤6 month	17/24 (71%)
6–12 month	5/24 (21%)
≥12 month	2/24 (8%)
Symptoms
Progressive dyspnea	19 (79%)
Fever	18 (75%)
Dry cough	16 (67%)
Expectoration	7 (29%)
Oxygen saturation while breathing ambient air
>96%	11/24 (46%)
91–96%	6/24 (25%)
<91%	7/24 (29%)
CT presentations
Diffuse ground-grass shadows	24/24 (100%)
Air bronchogram	4/24 (17%)
Pleural effusion	4/24 (17%)
Pleural thickening	1/24 (4%)
Multiple nodules	1/24 (4%)
Laboratory tests— mean/median
1,3-β-D-glucan >10 pg/mL	259.16 ± 392.34 pg/mL (16/20, 80%)
C-reactive protein >8 mg/L	37.85 (52.55) mg/L (15/20, 75%)
Percentage of neutrophils >75%	82.4 (15.9)% (15/21, 71%)
White blood cell count >9.5 × 10^9/L	8.11 ± 4.30 × 10^9/L (5/21, 24%)
Procalcitonin >0.5 ng/mL	0.16 (0.49) ng/mL (5/15, 33%)
Percentage of CD4^+ T cells <28.5%	34.6 ± 11.9% (5/23, 22%)
Percentage of CD3^+ T cells <59.4%	76.98 ± 11.08% (1/23, 4%)
Sputum culture
Cytomegalovirus	2/18 (11%)
Klebsiella pneumoniae	2/16 (13%)
Acinetobacter baumannii	1/16 (6%)
Pseudomonas aeruginosa	1/16 (6%)
Etiology
Bronchoalveolar lavage	14/17 (82%)
Induced sputum	9/11 (82%)
Sputum smears	1/24 (4%)
Mean hospitalization days (range) – days	17 ± 7 (5–33)
≤14 d	8/24 (33%)
14–21 d	10/24 (42%)
≥21 d	6/24 (25%)
Median cost— RMB (exclude the dead)	14,644.73 ± 11,101.59
≤10,000 RMB	8/24 (33%)
10,000–20,000 RMB	10/24 (42%)
≥20,000 RMB	6/24 (25%)
Oxygen therapy
Nasal oxygen breath	19/24 (79%)
Mask oxygen	2/24 (8%)
Noninvasive ventilation	1/24 (4%)
Invasive ventilation	1/24 (4%)
Extracorporeal membrane oxygen	1/24 (4%)
Treatment outcome
Recovery	20/24 (83%)
Death	4/24 (17%)

Figure 1 Computed tomography (CT) showed ground-glass opacities in the apexes of both lungs in the initial phase of Pneumocystis pneumonia (PCP). (A) A 31-year-old male patient underwent parental-origin renal transplantation (RT) after 3 years of hemodialysis, and PCP occurred 7 months after RT. In the early stages, CT showed ground-glass opacities in the apexes of both lungs. (B) A 37-year-old female patient underwent RT after 8 years of hemodialysis, and PCP occurred 3 months after surgery. CT showed a decrease in the transmittance of the two lungs, and diffuse, plaque-like, and strip-like opacities were seen in both apexes. (C) A 30-year-old male patient underwent RT after 1 year of hemodialysis, and PCP occurred 3 months after RT. CT showed increased clouding and ground-glass opacities in the apexes of both lungs, and the edges were unclear. (D) A 39-year-old male patient underwent RT after 5 years of hemodialysis, and PCP occurred 3 months after surgery. CT showed ground-glass and strip-like, high-density shadows scattered across the apexes of both lungs.

Figure 2 Lung CT showed diffuse, plaque-like, ground-glass opacities in both lungs. (A) A 37-year-old male patient underwent RT after 4 years of hemodialysis, and PCP occurred 4 months after surgery. CT showed plaque-like, grid-like, high-density shadows and clouding in both lung fields, with blurred edges. (B) A 40-year-old female patient underwent RT after 1 year of peritoneal dialysis, and PCP occurred 5 months after surgery. CT showed increased multiple plaque-like opacities in the lungs, and the edges were unclear. (C) A 36-year-old male patient underwent RT after 1 year of hemodialysis, and PCP occurred 3 months after surgery. CT showed diffuse, ground-glass, high-density shadows in both lungs, with unclear edges. (D) A 34-year-old male patient underwent RT after 2 years of hemodialysis, and PCP occurred 4 months after surgery. CT showed scattered, plaque-like opacities in both lungs with unclear edges.