Epidemiology and risk factors associated with Pneumocystis jirovecii pneumonia in kidney transplant recipients after 6‐month trimethoprim‐sulfamethoxazole prophylaxis: A case‐control study. Issue 2 (24th January 2020)

• Record Type: Journal Article
• Authors: Park, Se Yoon; Jung, Joo Hee; Kwon, Hyunwook; Shin, Sung; Kim, Young Hoon; Chong, Yong‐Phil; Lee, Sang‐Oh; Choi, Sang‐Ho; Kim, Yang Soo; Woo, Jun Hee; Kim, Sung‐Han; Han, Duck Jong
• Is Part Of: Transplant infectious disease. Volume 22:Issue 2(2020)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2020-01-24
• Subjects: cytomegalovirus -- Pneumocystis jirovecii pneumonia -- rejection; Transplantation of organs, tissues, etc -- Complications -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 617.01
• DOI: 10.1111/tid.13245
• Languages: English
• ISSNs: 1398-2273

Abstract

Abstract: Background: Pneumocystis jirovecii pneumonia (PCP) is an important cause of morbidity and mortality in kidney transplant recipients (KTRs), and prophylaxis with trimethoprim‐sulfamethoxazole (TMP‐SMX) is recommended. The aim of this study was to investigate incidence and risk factors for PCP in KTRs after 6‐month TMP‐SMX prophylaxis. Methods: We conducted a case‐control study of patients with PCP who received 6‐month PCP prophylaxis with TMP‐SMX after kidney transplantation (KT). In cases of rejection, PCP prophylaxis was provided for six additional months after anti‐rejection therapy. Cytomegalovirus (CMV) infection was not considered an indication for PCP prophylaxis due to concerns of nephrotoxicity associated with TMP‐SMX. Results: Among 3941 kidney or pancreas‐kidney transplant recipients, 67 (1.7%) developed PCP after discontinuing TMP‐SMX. A total of 47 patients with KT PCP and 94 controls were included. Duration of PCP prophylaxis was similar between cases and controls (median 6 months, P = .53). In multivariate analysis, rejection (OR 3.9; 95% CI 1.4‐11.1) and CMV infection (OR 2.4; 95% CI 1.0‐5.8) were independently associated with PCP development after TMP‐SMX. Rejection or CMV infection was observed in 70% of patients with PCP. Time to PCP development after rejection (median [IQR] 6 [5‐19] months) was slightly shorter than after CMV infection (median [IQR] 9 [5‐12] months; P = .18). Conclusion: Post‐prophylaxis PCP occurred in <2% of KTRs, and about two‐thirds of these experienced rejection or CMV infection. These data suggest that at least 6 to 9‐month additional chemoprophylaxis may be needed to prevent PCP in KTRs with transplant rejection or CMV infection.