Pneumocystis carinii Pneumonia—Transplant Lung

Abstract

Of 81 patients receiving cadaveric renal transplantation 11 developed a syndrome including insidious onset of dyspnoea, low PO2 and pCO2 and frequently a characteristic chest X-ray. Seven patients died of respiratory failure and at necropsy Pneurnocystis carinii was found in five of the six patients examined. One other patient was shown to have Pneumocystis carinii pneumonia by lung biopsy. Inclusion bodies suggesting cytomegalovirus infection were found in the lungs of four patients but were not thought to be a major contributing factor to respiratory failure. Serial studies of pulmonary function were performed in six patients, three of whom developed the sydrome, before and after renal transplantation. The effect of ‘transplant lung’ on pulmonary gas transfer was obscured to some extent by the existence of ventilation/perfusion abnormalities before the syndrome developed, and even before operation. However, an increase in alveolar-to-arterial oxygen-tension difference was a consistent finding, and arterial pO2 was always abnormally low during the severe stage of the syndrome. The hypoxia appeared to be mainly due to gross underventilation of perfused lung. Carbon monoxide transfer was reduced at the time of the syndrome. Spirometry did not show a consistent pattern but some patients showed ‘restrictive’ features compatible with reduced compliance.