Objective To summarize the managements of Pneumocystis jiroveci pneumonia(PJP)in an early stage after orthotopic liver transplantation(LT),explore the risk factors for an onset of disease and optimize its therapeutic outcomes.Methods From December 2020 to December 2023,the relevant clinical data were retrospectively reviewed for 5 PJP patients after LT.The diagnostic and therapeutic experiences were summarized from the aspects of clinical manifestations,early diagnosis,treatment planning,process monitoring and disease outcomes.Results There were 3 males and 2 females.A definite diagnosis of PJP was made by metagenomic next generation sequencing(mNGS).The positive rates of serum(1,3)-fi-D-glucan assay(G assay)and lactate dehydrogenase(LDH)were both 100％.Two patients received oral endotracheal intubation and ventilator-assisted breathing.One case died while the remainders were discharged smoothly.Three patients received non-invasive ventilation or nasal high-flow oxygen inhalation assistance and eventually recovered.Conclusion Early detection of mNGS in bronchoalveolar lavage fluid may quickly identify the pathogens and compensate for the deficiencies of traditional testing methods.The levels of G assay and LDH are markedly elevated in PJP.With a high sensitivity in diagnosing the pathogen of infection,it is not specific.During treatments,it is necessary to dynamically adjust immunosuppressive regimens and antibiotic doses based upon immune status,organ function status and clinical manifestations.Mortality rate of patients on invasive mechanical ventilation remains high.
关键词
肝移植/耶氏肺孢子菌/巨细胞病毒/肺炎/免疫抑制/宏基因组二代测序
Key words
Liver transplantation/Pneumocystis jiroveci/Cytomegalovirus/Pneumonia/Immunosuppression/Metagenomics next generation sequencing
维普
万方数据