부산대학교 도서관

Kidney transplantation is a cost-effective alternative for the treatment of end-stage renal disease, with clear survival and quality of life benefits. Infection is an important drawback in kidney transplantation and is second only to cardiovascular disease as a cause of death. Pulmonary infections occur in 8-16 of all kidney transplant patients, with mortality ranging from 12–16 in more recent studies. Bacteria as a group, Cytomegalovirus, Pneumocystis carinii, Legionella, and fungi, are the main agents. Although noninvasive methods are recommended for etiologic diagnosis, bronchoscopy or open lung biopsy is mandatory in the great majority of the cases. Both transbronchial biopsy and open lung biopsy provide more information about the etiologic agent compared with bronchoalveolar lavage alone, and open lung biopsy has a higher diagnostic yield, although it may be associated with more frequent and serious adverse events. Broad-spectrum empiric antimicrobial therapy should be instituted at the same time as an invasive diagnostic method is performed and treatment adjusted according to subsequent results. Empiric antimicrobial treatment and the invasive diagnostic method should be selected according to the severity of respiratory impairment, time of onset of disease after transplantation, the radiologic pattern, and specific epidemiological factors.