公民逝世后器官捐献供肾肾移植术后肺部感染风险因素分析

目的  探讨公民逝世后器官捐献供肾肾移植术后受者发生肺部感染的影响因素。 方法  回顾性分析中南大学湘雅三医院器官移植中心自2010年4月至2014年12月公民逝世后器官捐献供肾肾移植125例供者与210例受者的临床资料。根据移植术后有否发生肺部感染将受者分为肺部感染组(37例)和无肺部感染组(173例)。了解肺部感染受者的一般情况和预后。对供者因素(性别、年龄、维持治疗时间、感染史)、受者因素[性别、年龄、吸烟史、糖尿病史，术前血红蛋白、白细胞、中性粒细胞百分比、白蛋白、血清肌酐等水平，术后有否急性排斥反应、有否使用生物制剂、有否预防性应用更昔洛韦及复方磺胺甲噁唑(SMZ)]进行单因素分析和多因素Logistic回归分析，找出肺部感染的独立危险因素。 结果与结论  37例肺部感染患者中，8例发展为重症肺部感染死亡。公民逝世后器官捐献供肾肾移植术后受者发生肺部感染的独立危险因素包括供体维持治疗时间、有感染史，受体吸烟史、糖尿病史、无预防性应用更昔洛韦或SMZ。

Analysis on risk factors of pulmonary infection after renal transplantation from organ donation after citizen's death

Objective To investigate the risk factors of pulmonary infection after renal transplantation from organ donation after citizen's death. Methods Clinical data of 125 donors and 210 recipients admitted to Organ Transplantation Center, the Third Xiangya Hospital of Central South Hospital from April 2010 to December 2014 were retrospectively analyzed. All recipients were divided into the pulmonary infection (n=37) and non-pulmonary infection groups (n=173) according to the incidence of pulmonary infection after renal transplantation. General data and clinical prognosis of the recipients with pulmonary infection were evaluated. Risk factors of the donors (gender, age, maintenance therapy time, infection history) and those of the recipients [gender, age, smoking history, diabetes mellitus history, preoperative levels of hemoglobin, leukocyte, percentage of neutrophilic leukocyte, albumin and serum creatinine, postoperative presence of acute rejection, use of biological agents and preventive application of ganciclovir and compound sulfamethoxazole (SMZ)] were subject to single factor analysis and multi-variate Logistic regression analysis to identify the independent risk factors of pulmonary infection. Results and conclusions Among 37 patients with pulmonary infection, 8 died due to progression to severe pulmonary infection. The independent risk factors of pulmonary infection following renal transplantation from organ donation after citizen's death include maintenance therapy time and infection history for the donors, smoking history, diabetes mellitus history and preventive use of ganciclovir or SMZ for the recipients.