Adjunctive Glucocorticoid Therapy for Pneumocystis jirovecii Pneumonia in Solid Organ Transplant Recipients: A Multicenter Cohort, 2015-2020.

Publication

Adjunctive Glucocorticoid Therapy for Pneumocystis jirovecii Pneumonia in Solid Organ Transplant Recipients: A Multicenter Cohort, 2015-2020.

Journal Paper/Review - Nov 15, 2023

Hosseini-Moghaddam Seyed M, Kothari Sagar, Humar Atul, Albasata Hanan, Yetmar Zachary A, Razonable Raymund R, Neofytos Dionysios, D'Asaro Matilde, Boggian Katia, Hirzel Cédric, Khanna Nina, Manuel Oriol, Müller Nicolas J., Imlay Hannah, Kabbani Dima, Tyagi Varalika, Smibert Olivia C, Nasra Mohamed, Fontana Lauren, Obeid Karam M, Apostolopoulou Anna, Zhang Sean X, Permpalung Nitipong, Alhatimi Hind, Silverman Michael S, Guo Henry, Rogers Benjamin A, MacKenzie Erica, Pisano Jennifer, Gioia Francesca, Rapi Lindita, Prasad G V Ramesh, Banegas Marcela, Alonso Carolyn D, Doss Kathleen, Rakita Robert M, Fishman Jay A

Citation

Hosseini-Moghaddam S, Kothari S, Humar A, Albasata H, Yetmar Z, Razonable R, Neofytos D, D'Asaro M, Boggian K, Hirzel C, Khanna N, Manuel O, Müller N, Imlay H, Kabbani D, Tyagi V, Smibert O, Nasra M, Fontana L, Obeid K, Apostolopoulou A, Zhang S, Permpalung N, Alhatimi H, Silverman M, Guo H, Rogers B, MacKenzie E, Pisano J, Gioia F, Rapi L, Prasad G, Banegas M, Alonso C, Doss K, Rakita R, Fishman J. Adjunctive Glucocorticoid Therapy for Pneumocystis jirovecii Pneumonia in Solid Organ Transplant Recipients: A Multicenter Cohort, 2015-2020. Am J Transplant 2023

Type

Journal Paper/Review (English)

Journal

Am J Transplant 2023

Publication Date

Nov 15, 2023

Issn Electronic

1600-6143

Brief description/objective

Solid organ transplant recipients (SOTRs) frequently receive adjunctive glucocorticoid therapy (AGT) for Pneumocystis jirovecii pneumonia (PJP). This multicenter cohort of SOTRs with PJP admitted to 20 transplant centers in Canada, the United States, Europe, and Australia, examined whether AGT was associated with a lower rate of all-cause intensive care unit (ICU) admission, 90-day in-hospital death, or a composite outcome (ICU admission or death). Of 172 SOTRs with PJP [median (IQR) age: 60 (51.5-67.0) years, 58 female (33.5%)], the ICU admission and death rates were 43.4%, and 20.8%, respectively. AGT was not associated with a reduced risk of ICU admission [aOR (CI95%): 0.49 (0.21-1.12)], death [aOR (CI95%): 0.80 (0.30-2.17)], or the composite outcome [aOR (CI95%): 10.97 (0.71-1.31)] in the propensity score-adjusted analysis. AGT was not significantly associated with at least 1-unit SOFA (the respiratory portion of the Sequential Organ Failure Assessment score) improvement by day 5 [12/37 (32.4%) vs 39/111 (35.1%), p=0.76)]. We did not observe significant associations between AGT and ICU admission or death in SOTRs with PJP. Our findings should prompt a re-evaluation of routine AGT administration in post-transplant PJP treatment and highlight the need for interventional studies.