Background: Pneumocystis jiroveci pneumonia (PJP) affected ~16% of solid organ transplant recipients (SOTRs) prior to universal prophylaxis (PPX), typically with trimethoprim-sulfamethoxazole (TMP-SMX). Guidelines recommend 6–12 months post SOT; optimal duration has not been established with current immunosuppressive regimens (IS).
Methods: A single-center, retrospective 1:4 case-control study of PJP among SOTRs from Jan 1998-Dec 2013 matched by nearest date of SOT was conducted. Cases had positive PJ direct fluorescent antibody assay of respiratory specimens. T-test, Chi-square, and Fisher's exact tests were performed.
Results: 15 cases were identified (rate 0.26%); 14 cases analyzed vs 56 controls (Table 1). Most cases were in kidney transplant recipients at a mean of 6.1 years post SOT. None was receiving PPX at diagnosis. Nearly all (86%) were treated with reduced IS, TMP-SMX, and steroids; 8 (43%) required ICU care. Cases tended to be older (p=0.055) and have higher serum creatinine (p=0.086). There were no differences in IS or incidence of acute rejection. PJP occurred more frequently in SOTRs with prior viral infection (64% vs 32%, p=0.028, OR 3.8) and in those with lower absolute lymphocyte counts (ALC) at diagnosis (700 vs 1272 cells/ul, p=0.007); odds of infection was high if ALC was less than or equal to 500 (OR 17.1 [CI 3.8-76.8]). Mortality was 21%.
Conclusion: PJP is a rare, late complication of SOT resulting in significant morbidity and mortality. Severe lymphopenia and post-SOT viral infection may identify SOTRs who warrant longer PPX to prevent this life threatening infection.
M. Angarone, None
A. Yang, None
V. Stosor, None
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