Pneumocystis jiroveci Pneumonia in Solid Organ Transplantation: Associations With Infection and Implications for Prophylaxis
Year: 2015
Type: article
Study design: Observational Study
Abstract: Background. Pneumocystis jiroveci pneumonia (PJP) affected ∼16% of solid organ transplant recipients (SOTRs) prior to universal prophylaxis (PPX), typically with trimethoprim-sulfamethoxazole (TMP-SMX). Guidelines recommend 6–12 months post SOT; optimal duration has not been established with current immunosuppressive regimens (IS). Methods. A single-center, retrospective 1:4 case-control study of PJP among SOTRs from January 1998 to December 2013 matched by nearest date of SOT was conducted. Cases had positive PJ direct fluorescent antibody assay of respiratory specimens. T-test, χ2, and Fisher's exact tests were performed. Results. 15 cases were identified (rate 0.26%); 14 cases analyzed versus 56 controls (table 1). Most cases were in kidney transplant recipients at a mean of 6.1 years post SOT. None was receiving PPX at diagnosis. Nearly all (86%) were treated with reduced IS, TMP-SMX, and steroids; 8 (43%) required ICU care. Cases tended to be older (p = 0.055) and have higher serum creatinine (p = 0.086). There were no differences in IS or incidence of acute rejection. PJP occurred more frequently in SOTRs with prior viral infection (64% versus 32%, p = 0.028, OR 3.8) and in those with lower absolute lymphocyte counts (ALC) at diagnosis (700 versus 1272 cells/µL, p = 0.007); odds of infection was high if ALC was less than or equal to 500 (OR 17.1 [CI 3.8-76.8]). Mortality was 21%. Conclusion. PJP is a rare, late complication of SOT resulting in significant morbidity and mortality. Severe lymphopenia and post-SOT viral infection may identify SOTRs who warrant longer PPX to prevent this life threatening infection. Disclosures. All authors: No reported disclosures.
Source: Open Forum Infectious Diseases
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W2260879335