1487. Variability of Pneumocystis jirovecii Prophylaxis Use Among Pediatric Solid Organ Transplant Providers
Session: Poster Abstract Session: Respiratory Infections: Miscellaneous
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • PJP IDWeek_Final_9.27.18.pdf (432.5 kB)
  • Background:   Pneumocystis jirovecii pneumonia (PJP) prophylaxis after pediatric solid organ transplant (SOT) is routinely recommended, but practice patterns vary. 

    Methods: In 2018, an online survey was sent to 707 members of the International Pediatric Transplant Association. 

    Results: 105 responded, representing 47 institutions in 18 countries.  Majority were transplant physicians (66%) or transplant surgeons (20%).  Remainder were nurse practitioners (6%), infectious disease physicians (5%) or pharmacists (4%). 

    Routine PJP prophylaxis was reported by 87%, while 13% do not routinely administer any prophylaxis.  The majority not using PJP prophylaxis performed only renal transplants (67%) and listed low incidence of PJP infection as the primary reason (88%). 

    Trimethoprim/sulfamethoxazole (TMP/SMX) was the preferred first line agent (97%).  Common second line agents were dapsone (33%), inhaled pentamidine (33%), and atovaquone (12%).

    Of those that provide PJP prophylaxis following renal transplant (n=51), the majority (51%) provide 4-6 months (Figure 1).  Durations following liver transplant (n=25) were similar; and heart transplant providers (n=24) most commonly give 4-6 months (42%) as well. Majority of abdominal multivisceral (MVS) providers (55%) give 10-12 months and most lung transplant responders provide lifelong prophylaxis (81%).  Across all organs, at least 20% provide lifetime prophylaxis.  After completion of PJP prophylaxis, 36% do not restart for any reason and 54% would restart for treatment of acute graft rejection.

    Reported PJP infections were uncommon with 80% reporting no PJP cases in the prior 12 months and 15% reporting 1-5 infections.  Only 2% reported a case of PJP infection on prophylaxis.

    Conclusion:   PJP prophylaxis remains routine for the majority of pediatric SOT patients; albeit with notable practice variations.  The most common duration of PJP prophylaxis following renal, liver and heart transplant was 4-6 months; while in abdominal multivisceral and lung transplant recipients, durations of either 10-12 months or lifelong prophylaxis were common.  There remains a lack of evidence-based guidelines balancing the utility of PJP prevention against potential treatment side effects and unnecessary medication use.

    Figure 1 - Duration of PJP Prophylaxis

     

    Grant Paulsen, MD, Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, Marian Michaels, MD, MPH, Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, Lara Danziger-Isakov, MD, MPH, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, Anne Dipchand, MD, Transplant and Regenerative Medicine Centre, Hospital for Sick Children, Toronto, ON, Canada, Michael Green, MD, MPH, FIDSA, Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA and Mignon McCulloch, MD, University of Cape Town, Cape Town, South Africa

    Disclosures:

    G. Paulsen, None

    M. Michaels, None

    L. Danziger-Isakov, None

    A. Dipchand, None

    M. Green, None

    M. McCulloch, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.