Publikation

Pneumocystis jirovecii pneumonia in solid organ transplant recipients: a descriptive analysis for the Swiss Transplant Cohort

Wissenschaftlicher Artikel/Review - 28.08.2018

Bereiche
PubMed
DOI

Zitation
Neofytos D, Van Delden C, Manuel O, Cusini A, Boggian K, Mueller N, Khanna N, Lecompte T, Boely E, Hirzel C, Swiss Transplant Cohort Study. Pneumocystis jirovecii pneumonia in solid organ transplant recipients: a descriptive analysis for the Swiss Transplant Cohort. Transpl Infect Dis 2018:e12984.
Art
Wissenschaftlicher Artikel/Review (Englisch)
Zeitschrift
Transpl Infect Dis 2018
Veröffentlichungsdatum
28.08.2018
eISSN (Online)
1399-3062
Seiten
e12984
Kurzbeschreibung/Zielsetzung

BACKGROUND
Descriptive data on Pneumocystis jirovecii pneumonia (PJP) in solid organ transplant recipients (SOTr) in the era of routine Pneumocystis-prophylaxis are lacking.

METHODS
All adult SOTr between 2008-2016 were included. PJP was diagnosed based on consensus guidelines. Early-onset PJP was defined as PJP within the 1st-year-post-transplant.

RESULTS
41/2842 SOTr (1.4%) developed PJP (incidence rate: 0.01/1000 person-days) at a mean of 493-days post-transplant: 21 (51.2%) early vs 20 (48.8%) late-onset PJP. 2465 (86.7%) SOTr received Pneumocystis-prophylaxis for a mean 316 days. PJP incidence was 0.001% and 0.003% (log-rank<0.001) in SOTr with and without Pneumocystis-prophylaxis, respectively. PJP was an early event in 10/12 (83.3%) SOTr who did not receive Pneumocystis-prophylaxis and developed PJP, compared to those patients who received prophylaxis (11/29, 37.9%; P-value: 0.008). Among late-onset PJP patients, most cases (13/20, 65%) were observed during the 2 year post-transplant. Age ≥65 years (OR: 2.4, P-value: 0.03) and CMV infection during the first 6 months post-SOT (OR: 2.5, P-value: 0.006) were significant PJP predictors, while Pneumocystis-prophylaxis was protective for PJP (OR: 0.3, P-value: 0.006) in the overall population. Most patients (35, 85.4%) were treated with trimethoprim-sulfamethoxazole for a mean 20.6 days. 1-year mortality was 14.6%.

CONCLUSIONS
In the Pneumocystis-prophylaxis-era, PJP remains a rare post-transplant complication. Most cases occurred post-PJP-prophylaxis-discontinuation, particularly during the 2 -year-post-transplant. Additional research may help identify indications for Pneumocystis-prophylaxis prolongation. This article is protected by copyright. All rights reserved.