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
L. Danziger-Isakov, None
A. Dipchand, None
M. Green, None
M. McCulloch, None