小剂量复方磺胺甲噁唑预防肾移植后肺孢子菌肺炎

背景：2009年肾脏病预后组织指南推荐所有肾移植受者移植后均应预防性使用复方磺胺甲噁唑预防肺孢子菌肺炎,但疗效有待观察。目的：观察肾移植移植后预防性应用小剂量复方磺胺甲噁唑预防早期肺孢子菌肺炎的疗效。方法：回顾性分析珠江医院器官移植科2006/2009期间接受肾移植患者的临床资料,移植后1年内规律随访并有完整的数据资料者,患者均排除肝炎、二次移植、群体反应性抗体阳性以及移植后失访等因素后纳入统计。记录入选患者的年龄、性别、免疫抑制诱导治疗方案、免疫抑制维持方案、皮疹、肝肾损害、急性排斥反应和耶氏肺孢子菌肺炎发病情况。其中部分患者接受复方磺胺甲噁唑预防肺孢子菌肺炎,设为预防组,部分患者未进行预防,设为非预防组。肺孢子菌肺炎通过病程分析、临床表现、影像学检查和实验室检查等确诊。结果与结论：围手术期中预防组与非预防组在年龄、性别、免疫诱导方案（生物制剂选用）、免疫维持方案和移植后1个月时血肌酐值均差异无显著性意义（P〉0.05）。随访期间患者急性排斥反应、巨细胞病毒感染、移植后1年肾功能等指标以及骨髓抑制、肝功能、药物性皮疹等方面差异无显著性意义（P〉0.05）;而肺孢子菌肺炎的发病率预防组较非预防组明显降低（P〈0.05）。结果证实,肾移植后预防应用小剂量复方磺胺甲噁唑能明显降低早期肺孢子菌肺炎的发生率。

Small-dose trimethoprim-sulfamethoxazole prevents pneumocystis pneumonia after renal transplantation

BACKGROUND： Kidney Disease： Improving Global Outcomes guidelines in 2009 recommend that all renal recipients should receive trimethoprim-sulfamethoxazole to prevent pneumocystis pneumonia. OBJECTIVE： To observe the effect of small-dose trimethoprim-sulfamethoxazole to prevent pneumocystis pneumonia in early stage of renal transplantation. METHODS： Clinical data from renal transplant recipients during 2006 and 2009 were collected retrospectively in accordance with certain exclusion criteria, such as, regularly follow-up with complete data, hepatitis, and secondary transplant, reactive antibody-positive and lost follow-up after transplantation. The gender, age, immune induction protocols, immune maintenance protocols, rash, damaged liver and renal function, acute rejection and pneumocystis pneumonia were recorded. The recipients receiving trimethoprim-sulfamethoxazole treatment were considered as prevention group and the recipients without treatment were considered as non-prevention group. Pneumocystis pneumonia was diagnosed by medical history, clinical manifestation, computed tomography and laboratory inspection. RESULTS AND CONCLUSION： There was no significant difference of age, gender, immune reduction protocols （selection of biological agents）, immune maintenance protocols, blood creatinine content at 1 month after transplantation between prevention group and non-prevention group in perioperative period （P 〉 0.05）, while there was no significant difference of acute rejection, cytomegalovirus, renal function indicators at 1 year post-transplantation, and as well as bone marrow suppression, liver function, drug-induced rash between two groups after 1-year follow-up （P 〉0.05）; the incidence of pneumocystis pneumonia in prevention group was significantly decreased when compared with that in the non-prevention group （P 〈 0.05）. Small dosage of trimethoprim-sulfamethoxazole takes significant prevention effect on pneumocystis pneumonia.