Early- and late-onset severe pneumonia after renal transplantation.

backgroundThe aim of this study was to clarify the distinctions in the clinical characteristics and outcomes between early- and late-onset severe pneumonia after renal transplantation requiring ICU admission.

methodsThe data were retrospectively collected in consecutive renal recipients with severe pneumonia from January 1, 2009, to December 31, 2013, in a tertiary ICU. We classified the patients according to the time of pneumonia onset as follows: early-onset severe pneumonia (E-SP) corresponded to a pulmonary infection occurring during the first year following the transplantation, and late-onset severe pneumonia (L-SP) corresponded to a pulmonary infection occurring after the first year following the transplantation.

resultsIn the E-SP patients, fungi (42.1%) and viruses (31.6%) were the most common pathogens. Twenty-three (71.9%) patients received non-invasive ventilation (NIV), 15 (65.2%) of whom were intubated. The median duration of the ICU and hospital stays was 11 ± 5 and 19 ± 4 days, respectively. In the L-SP patients, bacteria (42.1%) and viruses (26.3%) were the predominant pathogens. Four of 15 (26.7%) patients failed NIV treatment. The median duration of the ICU and hospital stays was 9 ± 3 and 16 ± 3 days, respectively. The ICU mortality among the E-SP patients was 18.8% (6 of 32), compared with 7.1% (2 of 28) in the L-SP group (P = 0.264).

conclusionsEarly-onset severe pneumonia in renal transplant recipients resulted in a more serious condition, higher rate of NIV failure, longer duration of mechanical ventilation, and increased length of ICU and hospital stays.