401. Pneumocystis jirovecii pneumonia in renal transplant recipients after a 6-month trimethoprim-sulfamethoxazole prophylaxis: a case-control study
Session: Poster Abstract Session: Fungal Disease: Management and Outcomes
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • Poster_IDweek_2018_KT PCP_박세윤.pdf (357.9 kB)
  • Background: Pneumocystis jiroveci pneumonia (PCP) is an important cause of morbidity and mortality in kidney transplant recipients (KTRs). Chemoprophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) is recommended about 6 to 12 months after solid organ transplantation. However, PCP occasionally occurs after the recommended prophylaxis periods. The aim of this study was to investigate the incidence and risk factors for PCP in KTRs with 6-month TMP-SMX prophylaxis.

    Methods: We performed a case-control study of adult patients diagnosed with PCP from 1999 to 2015 in a tertiary care hospital. All patients received 6-month PCP prophylaxis with TMP-SMX after kidney transplantation (KT). If there were rejection episodes, PCP prophylaxis was provided for additional 3 months. During the study period, CMV viremia was not indication of PCP prophylaxis because of the concern of the nephrotoxicity of TMP-SMX. We defined the classification of early or late-onset PCP as one year after transplantation.

    Results: Among 3,941 kidney or pancreas-kidney transplant recipients, 67 (1.7%) patients developed PCP after the discontinuation of TMP-SMX prophylaxis. Among them, patients who was transferred from other hospitals (n=14) and pancreas-kidney transplant recipients (n=6) were excluded. Finally, 47 of KT PCP and 94 control patients were included. Of the 47 patients with PCP, 24 (51%) revealed early PCP while the remaining 23 (49%) exhibited late PCP. Duration of PCP prophylaxis was similar between case and control (median 6 months, respectively). In multivariate analysis, rejection (OR, 3.9; 95% CI, 1.4-11.1) and cytomegalovirus infection (OR, 2.4; 95% CI, 1.0-5.8) were independently associated with the development PCP after TMP-SMX prophylaxis. Rejection or CMV viremia were observed in 70% of patients with PCP patients. Time to development of PCP after rejection (median 6 months. IQR 5-19 months) was slightly shorter than that after CMV viremia (median 9 months, IQR 5-12 months), although this difference did not reach any statistical significance (p value = 0.18).

    Conclusion: Rejection and CMV viremia appear to be risk factors for the development of PCP after completing early transplantation period chemoprophylaxis. Our data suggest that at least 6 to 9-month chemoprophylaxis for PCP may be needed for KTRs with rejection or CMV viremia.

    Se Yoon Park, MD1, Sung Shin, MD2, Young-Hoon Kim, MD2, Joo Hee Jung, RN2, Sung-Han Kim, MD, PhD3 and Duck Jong Han, MD, PhD2, (1)Department of Infectious Diseases, Soonchunhyang University Seoul Hospital, Seoul, Korea, Republic of (South), (2)Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of (South), (3)Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of (South)

    Disclosures:

    S. Y. Park, None

    S. Shin, None

    Y. H. Kim, None

    J. H. Jung, None

    S. H. Kim, None

    D. J. Han, None

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