Clinical Manifestations and Outcomes of Renal Transplantation Patients With Pneumocystis jirovecii Pneumonia and Cytomegalovirus Co-infection

Abstract

BackgroundPneumocystis jirovecii pneumonia (PJP) and cytomegalovirus (CMV) infection are common opportunistic infections among renal transplantation (RT) recipients, and both can increase the risk of graft loss and patient mortality after RT. However, few studies had evaluated PJP and CMV co-infection, especially among RT patients. Therefore, this study was performed to evaluate the impact of CMV co-infection with PJP among RT recipients.MethodsWe retrospectively analyzed the clinical data of patients with confirmed diagnosis of PJP between 2015 and 2021 in our hospital. We divided patients into PJP and PJP+CMV groups according to their CMV infection status, and the clinical severity and outcomes of the two groups were evaluated.ResultsA total of 80 patients after RT were diagnosed with PJP. Of these, 37 (46.2%) patients had co-existing CMV viremia. There were no statistically significant intergroup differences in age, sex, diabetes, onset time of PJP after RT and postoperative immunosuppressant. Compared to serum creatinine (Cr) at admission, the serum Cr at discharge in both the PJP and PJP+CMV groups were decreased. The PJP+CMV group had a higher C-reactive protein level, higher procalcitonin level, and lower albumin level than the PJP group. The PJP+CMV group showed a higher PSI score than the PJP group. Moreover, the initial absorption time of the lesion was longer in the PJP+CMV group. However, the duration of hospitalization showed no significant differences between the two groups. The mortality rate was 9.4-times higher in the PJP+CMV group than in the PJP group. The rate of admittance to the intensive care unit was 3.2-times higher in the PJP+CMV group than in the PJP group.ConclusionCMV co-infection may result in more serious inflammatory response. RT patients with PJP+CMV infection had more severe clinical symptoms, slower recovery from pneumonia, and higher mortality than those with PJP alone. Therefore, when RT patients present with severe PJP, the possibility of CMV co-infection should be considered. Short-term withdrawal of immunosuppressants in case of severe infection is safe for the renal function of RT patients.

Clinical characteristics and risk factors for late‐onset pneumocystis jirovecii pneumonia in kidney transplantation recipients

“…The sensitivity of hypoalbuminemia was more than 90% in ROC analysis. Previous studies suggested that hypoalbuminemia was associated with lung injury and serum albumin was an important independent factor for poor prognosis in HIV patients infected with PJP 2,37 . Hypoalbuminemia means poor nutrition status and the amount of immune globulins might be lowered, which might affect the immune function of the human body.…”

“…Pneumocystis jirovecii pneumonia (PJP), an opportunistic infection that is sometimes life-threatening, often occurs in individuals with impaired immunity. 1,2 Severe cases can develop respiratory failure and even die. 3,4 It initially attracted attention among human immunodeficiency virus (HIV) patients, 5 then in solid organ transplantation recipients, haematopoietic stem cell transplantation patients, and those who received corticosteroids and chemotherapy drugs.…”

“…Pneumocystis jirovecii pneumonia (PJP), an opportunistic infection that is sometimes life‐threatening, often occurs in individuals with impaired immunity 1,2 . Severe cases can develop respiratory failure and even die 3,4 .…”

“…PJP can occur at any time after kidney transplantation. Some previous research reported that PJP frequently occurs within 6 months after kidney transplantation 2 . Based on the epidemiology of pneumocystis jiroveci (PJ), in 2009, the KDIGO clinical practice guideline recommended that all kidney transplantation recipients should receive PJP prophylaxis by daily TMP‐SMX administration for 3–6 months after transplantation 11 .…”

Lung Quantitative Computer Tomography Analysis for Non-HIV Associated Pneumocystis Pneumonia Assessment：An Observational Clinical Cohort Study

“…Wang et al [5] found that decreased lymphocyte counts, and high doses of steroid administration were associated with in-hospital mortality of PCP. Additionally, there is accumulating evidence [21][22][23] indicating that PCP always co-infect with other pathogens. NLR can be regarded as a convenient index to re ect the integrated lymphocyte level adjusted by neutrophil to estimate the severity of PCP.…”