Chickenpox infection after renal transplantation.
Chickenpox infection after renal transplantation.
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DOI：
10.1093/ckj/sfs036
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发表时间：
2012-06
影响因子：
4.6
通讯作者：
Prasad N
中科院分区：
文献类型：
--
作者：
Kaul A;Sharma RK;Bhadhuria D;Gupta A;Prasad N
水痘，虽然是一种常见的感染儿童，是罕见的免疫功能低下的患者，特别是肾移植受者，并进行了非常高的发病率和死亡率。关于水痘在成人肾移植受者的数据很少，虽然报告表明，它可能遵循一个致命的过程，需要经常住院治疗，并在严重的情况下可能导致死亡。评价肾移植受者10年随访期间水痘/水痘感染的发生率、严重程度和并发症。从2000年6月至2010年6月的10年期间，在我们的活体相关肾移植项目中，1.48%的患者被诊断为水痘感染，患者中位年龄为39岁（范围21-54岁）。在感染后的5名患者中观察到移植物功能障碍，其中2名患者成为透析依赖型。其他三个有轻微的移植物功能障碍，他们随后恢复，这表明感染是负责移植物功能障碍。无一发生排斥反应后暴露或修改免疫抑制。我们所有的病人都需要入院，47.8%的病人有各种表现，睾丸炎、胰腺炎、脑炎和胃炎各占8.6%。所有患者均接受静脉注射阿昔洛韦2周，然后口服阿昔洛韦3个月。感染与13.4%的死亡率增加，由于额外的感染和中枢神经系统参与致命的双侧肺炎患者。这种感染是一种良性疾病，在一般人群中病程基本稳定，对免疫功能低下的患者可能有严重的结局，占近90%，在8.6%的感染患者中有显著的发病率和死亡率，因此突出了移植前疫苗接种在这一亚组人群中的重要性。
Chicken pox, although a common infection among children, is rare in immunocompromised patients, particularly renal transplant recipients, and carries a very high incidence of morbidity and mortality There is little data on chickenpox in adult renal transplant recipients, although reports have suggested that it may follow a virulent course requiring frequent hospitalization, and in severe cases can cause death. To evaluate the incidence, severity and complications of a varicella/chickenpox infection in renal transplant recipients over 10 years follow-up. An incidence of 1.48% of our patients were diagnosed with varicella infection during this 10-year period from June 2000 to June 2010 in our live-related renal transplant program, with a median patient age of 39 years (range 21–54 years). Graft dysfunction was observed among five patients following the infection, two of whom became dialysis-dependent. The other three had mild graft dysfunction from which they subsequently recovered, suggesting that infection was responsible for graft dysfunction. None of them developed rejection following exposure or with modification of immunosuppression. All of our patients required admission with 47.8% presenting with various presentations, with orchitis, pancreatitis, encephalitis and gastritis each affecting 8.6% of the patients. All patients were managed with intravenous acyclovir for 2 weeks followed by oral acyclovir for 3 months. The infection was associated with an increased mortality of 13.4% due to superadded infections and central nervous system involvement in one patient with fatal bilateral pneumonia. This infection, which is a benign disease with a largely stable course among the general population, can have severe outcomes for immunocompromised patients, accounting for almost 90% with significant morbidity and mortality in the 8.6% of infected patients, thus highlighting the importance of pre-transplant vaccination in this subgroup of the population.