CAJ | 학술논문

目的：分析DCD供肾移植肺部感染的特点及诊治效果。方法回顾性分析2011年6月至2014年12月施行的DCD供肾移植69例，以同期的尸体供肾移植129例作为对照组。所有受者均采用抗体诱导＋他克莫司（TAC）＋麦考酚酯（MMF）＋泼尼松（Pred）四联免疫抑制方案。分析总结DCD供肾移植术后肺部感染特征，治疗效果。结果随访6～24个月，DCD组和SCD组受者肺部感染总体发生率分别为17．4％和33．3％，移植术后半年内肺部感染发生率分别为15．9％和15．5％；DCD组肺部感染死亡3例，SCD组死亡4例。病原体的种类主要为卡氏肺囊虫、CMV；肺部感染治疗期间急性排斥反应发生各为3例和4例；肺部感染发生同受者DGF状态、感染前使用ATG相关，同供体携带病原体无显著性关联；肺部感染治疗前后受者移植肾功能无明显差异。结论 DCD供肾移植术后肺部感染发生率同尸体供肾移植相当，DGF和T细胞清除剂使用时主要诱因，经积极治疗后可以获得良好的结局。
목적：분석DCD공신이식폐부감염적특점급진치효과。방법회고성분석2011년6월지2014년12월시행적DCD공신이식69례，이동기적시체공신이식129례작위대조조。소유수자균채용항체유도＋타극막사（TAC）＋맥고분지（MMF）＋발니송（Pred）사련면역억제방안。분석총결DCD공신이식술후폐부감염특정，치료효과。결과수방6～24개월，DCD조화SCD조수자폐부감염총체발생솔분별위17．4％화33．3％，이식술후반년내폐부감염발생솔분별위15．9％화15．5％；DCD조폐부감염사망3례，SCD조사망4례。병원체적충류주요위잡씨폐낭충、CMV；폐부감염치료기간급성배척반응발생각위3례화4례；폐부감염발생동수자DGF상태、감염전사용ATG상관，동공체휴대병원체무현저성관련；폐부감염치료전후수자이식신공능무명현차이。결론 DCD공신이식술후폐부감염발생솔동시체공신이식상당，DGF화T세포청제제사용시주요유인，경적겁치료후가이획득량호적결국。
Objective To analyze the characteristics and the effect of the diagnosis and treatment of pulmo-nary infection in DCD kidney transplantation. Methods From Jan 2011 to December 2014,69 cases of DCD kid-ney transplantation were analyzed and 129 cases of SCD kidney transplantation were included as the control group. All cases were implemented with antibody induction + tacrolimus (TAC)+ mycophenolate (MMF)+prednisone (Pred)quadruple immunosuppressive scheme. We analyzed the characteristics,therapeutic effect of pulmonary infection after kidney transplantation. Results Followed up for 6~24 months,the overall occurrence rate of pulmonary infection is 17 . 4% vs 33 . 3%. The incidence rate within six months after transplantation is 15. 9% vs 46. 5%. In group DCD,3 cases died of pulmonary infection,while 4 cases in SCD group. The pathogen types mainly included Pneumocystis carinii and cytomegalovirus (CMV). 3 cases in DCD group and 4 cases in SCD group occurred acute rejection during the period of pulmonary infection. The recipient DGF status and the use of ATG were closely related with pulmonary infection. The donor carried with pathogens was not rele-vant to the receiver’s infection. In addition,there were no significant difference of serum creatine before and af-ter treatment . Conclusions There is no significant difference of occurrence rate of pulmonary infection between kidney transplantation receivers of DCD and SCD. The DGF status and ATG application are the two major risk factors. The active treatment can obtain good outcomes.