دورية أكاديمية
Aggressive immunosuppressant reduction and long-term rejection risk in renal transplant recipients with Pneumocystis jiroveci pneumonia.
| العنوان: | Aggressive immunosuppressant reduction and long-term rejection risk in renal transplant recipients with Pneumocystis jiroveci pneumonia. |
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| المؤلفون: | Yang CY; Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital; and the School of Medicine, National Yang-Ming University, Taipei, Taiwan., Shih CJ, Yang WC, Lin CC |
| المصدر: | Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation [Exp Clin Transplant] 2012 Aug; Vol. 10 (4), pp. 344-9. Date of Electronic Publication: 2012 Jul 05. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Bas̜kent University Country of Publication: Turkey NLM ID: 101207333 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2146-8427 (Electronic) Linking ISSN: 13040855 NLM ISO Abbreviation: Exp Clin Transplant Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: [Ankara] : Bas̜kent University, c2003- |
| مواضيع طبية MeSH: | Graft Rejection/*immunology , Immunosuppressive Agents/*administration & dosage , Immunosuppressive Agents/*adverse effects , Kidney Transplantation/*immunology , Pneumocystis carinii/*isolation & purification , Pneumonia, Pneumocystis/*immunology , Pneumonia, Pneumocystis/*microbiology, Acute Disease ; Adult ; Aged ; Bronchoalveolar Lavage Fluid/microbiology ; Chi-Square Distribution ; Drug Administration Schedule ; Drug Therapy, Combination ; Female ; Graft Rejection/prevention & control ; Hospital Mortality ; Hospitalization ; Humans ; Kidney Transplantation/adverse effects ; Kidney Transplantation/mortality ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Pneumonia, Pneumocystis/diagnosis ; Pneumonia, Pneumocystis/mortality ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Taiwan ; Time Factors ; Treatment Outcome |
| مستخلص: | Objectives: Pneumocystis jiroveci pneumonia is a rare but lethal complication in renal transplant recipients. Dose reduction of immunosuppressive agents in such situations is recommended, but its quantity and safety are unclear. Materials and Methods: From January 2001 to January 2011, twenty of one thousand forty-six renal transplant recipients in a single center developed Pneumocystis jiroveci pneumonia, which was diagnosed by the Giemsa and Gomori methenamine silver stains from a specimen of bronchoalveolar lavage. Results: We found that timing of the first immunosuppressant reduction of the Pneumocystis jiroveci pneumonia survivor (mean, 1.4 days after admission) was significantly earlier than that of the deceased patient (mean, 5.1 days after admission). Logistic regression analysis indicated that for those whose immunosuppressants were reduced more aggressively (either 1 of the immunosuppressants was reduced by more than 50% within 2 days of hospitalization) were significantly more likely to survive (mortality risk, OR, 0.074 [95% CI, 0.01-0.84]; P = .035). In addition, none of the survivors developed acute rejection or allograft necrosis during a mean follow-up of 2 years. Conclusions: Dosage reduction of immunosuppressive agents in renal transplant recipients with Pneumocystis jiroveci pneumonia should be prompt and sufficient. Aggressive immuno-suppressant dosage reduction is safe in such circumstance and is associated with minimal risk of in-hospital and long-term acute allograft rejection. |
| المشرفين على المادة: | 0 (Immunosuppressive Agents) |
| تواريخ الأحداث: | Date Created: 20120707 Date Completed: 20121214 Latest Revision: 20201209 |
| رمز التحديث: | 20240829 |
| DOI: | 10.6002/ect.2012.0015 |
| PMID: | 22765304 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 2146-8427 |
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| DOI: | 10.6002/ect.2012.0015 |