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

Journal Paper/Review - Aug 28, 2018

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Citation
Neofytos D, Hirzel C, Boely E, Lecompte T, Khanna N, Mueller N, Boggian K, Cusini A, Manuel O, Van Delden 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.
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Journal Paper/Review (English)
Journal
Transpl Infect Dis 2018
Publication Date
Aug 28, 2018
Issn Print
Issn Electronic
1399-3062
Pages
e12984
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Brief description/objective

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.