Pneumocystis jirovecii pneumonia is rare in renal transplant recipients receiving only one month of prophylaxis

Abstract

Prophylaxis against Pneumocystis jirovecii pneumonia (PCP) is recommended for at least 4-12 months after solid organ transplant. In our center, renal transplant recipients receive only 1 month of post-transplant trimethoprim-sulfamethoxazole, which also may provide limited protection against Nocardia. We identified only 4 PCP cases and 4 Nocardia cases in 1352 patients receiving renal and renal-pancreas transplant from 2003 to 2009 at the University of Michigan Health System. Two PCP cases were identified <1 year after transplant, and 2 PCP cases were identified >1 year after transplant (gross attack rate 4/1352, 0.3%). Two Nocardia cases were identified <1 year after transplant, and 2 cases were identified >1 year after transplant. All identified cases received induction therapy (7 of 8 with anti-thymocyte globulin), whereas about one-half of all renal transplant patients received induction therapy at our institution. No patient was treated for rejection within 6 months of PCP; 2 of 4 patients with PCP had recent cytomegalovirus infection. All patients with PCP and 3 of 4 patients with Nocardia survived. The benefits of prolonged PCP prophylaxis should be weighed against the adverse events associated with prolonged use of antimicrobials.

Risk Factors of Pneumocystis Pneumonia in Solid Organ Recipients in the Era of the Common Use of Posttransplantation Prophylaxis

“…Nevertheless, the inclusion of all the PCR-positive patients did not change the statistical results. The size of the study population could also restrict the conclusions although, to our knowledge, it is, to date, the largest study performed on SOT patients with PCP who received a posttransplantation prophylaxis (3,24,(33)(34)(35)(36)51). Moreover, this study was carried out on SOT recipients of all kinds but the study population is dominated by kidney transplant recipients.…”

“…Historically, rates of PCP pneumonia after SOT were generally around 5-15% (3,13,14). Today, probably due to the generalization of primary prolonged prophylaxis with TMP-SMX, PCP is a relatively rare infection in SOT recipients as most recent studies report lower rates of PCP from 0.3% to 2.6% (23,(34)(35)(36).…”

Pneumocystis jiroveciiPneumonia in Patients with or without AIDS, France

“…Among non-AIDS patients in this study, 99 (30.8%) were SOT recipients, a population for which recent guidelines recommend PCP prophylaxis for 6–12 months, a period that might be extended on the basis of level of immunosuppression and immunosuppressive drug requirements ( 18 , 19 ). Despite this recommendation, however, recent studies suggest that 1 month of prophylaxis would be sufficient for kidney transplant patients ( 20 ). Given the high rate of death in our cohort, this conclusion should be challenged.…”

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

“…Pneumocystis jirovecii pneumonia (PJP) is a rare complication in solid organ transplant recipients (SOTr), as a result of routine Pneumocystis ‐prophylaxis applied in most transplant centers . In the absence of effective prophylaxis, 5%‐15% SOTr may develop PJP post‐transplant . Most experts and existing guidelines agree that Pneumocystis ‐prophylaxis should be administered for 12 months (Europe) to indefinitely (United States of America, USA) in lung and heart transplant recipients, and for 3‐6 months (Europe) or 6‐12 months post‐transplant (USA) post‐kidney or liver transplant .…”