Pneumocystis jiroveci remains an important respiratory pathogen in immunocompromised individuals. Historically, without prophylaxis, the incidence of Pneumocystis pneumonia (PCP) in HIV-negative solid organ transplant (SOT) recipients ranged from 5% to 15%. 1-3 PCP results in significant disease burden in SOT recipients, with mortality rates ranging from 5% to 50% depending on the transplanted organ. 4 Trimethoprim-sulfamethoxazole (TMP/SMX) remains the drug of choice for primary prophylaxis. 5 Atovaquone, dapsone, and pentamidine are reasonable alternatives for those with intolerance to TMP/ SMX. Kidney transplant recipients are most at risk for PCP during periods of heightened immunosuppression. This is usually during the first 6 to 12 months after transplant and during treatment for acute rejection. For HIV-negative recipients, the European guidelines recommend at least 4 months of PCP prophylaxis after transplant. 6 The Kidney Disease Improving Global Outcomes recommends 3 to 6 months of routine prophylaxis. 7 With the widespread use of prophylaxis, PCP is almost non-existent in the first year after kidney transplant among HIV-negative recipients. It is now more commonly seen in the second post-transplant year or even more delayed, occurring 6 to 10 years later. 4,[8][9][10] The global incidence of PCP during