J Korean Soc Transplant.  2018 Dec;32(4):92-103. 10.4285/jkstn.2018.32.4.92.

Proposal of a Selective Prophylaxis Strategy Based on Risk Factors to Prevent Early and Late Pneumocystis jirovecii Pneumonia after Renal Transplantation

• Lee H
• Han A
• Choi C
• Ahn S
• Min SI
• Min SK
• Lee H
• Kim YS
• Yang J
• Ha J

• KMID: 2430589
• DOI: http://doi.org/10.4285/jkstn.2018.32.4.92

Abstract

BACKGROUND
Currently, trimethoprim-sulfamethoxazole is used for Pneumocystis jirovecii pneumonia (PJP) prophylaxis, but it is associated with frequent adverse effects. This study evaluated the efficacy and safety of the current protocol and proposes an individualized risk-based prophylaxis protocol.
METHODS
The PJP incidence and risk factors during the first 6 months (early PJP) and afterwards (late PJP) was assessed in renal transplant recipients with (prophylaxis group) and without (no-prophylaxis group) 6-month PJP prophylaxis.
RESULTS
In 578 patients, there were 39 cases of PJP during a median follow-up of 51 months. Renal adverse events were encountered frequently during trimethoprim-sulfamethoxazole prophylaxis, leading to premature discontinuation. Patients without the prophylaxis had a significantly higher incidence of early PJP (n=27, 6.6%) compared to patients with the prophylaxis (n=0). The incidence of late PJP was 2.2%, without between-group differences. The factors associated with early PJP were preoperative desensitization and acute rejection within 1 month, whereas late PJP was associated with age, deceased donor transplant, and acute rejection requiring antithymocyte globulin treatment.
CONCLUSIONS
Based on the simulation results of several risk-based scenarios, the authors recommend universal prophylaxis up to 6 months post-transplant and extended selective prophylaxis in patients aged ≥57 years and those with a transplant from deceased donors.

Keyword

Selective prophylaxis; Kidney transplantation; Pneumocystis jirovecii pneumonia

MeSH Terms

Antilymphocyte Serum
Follow-Up Studies
Humans
Incidence
Kidney Transplantation*
Pneumocystis jirovecii*
Pneumocystis*
Pneumonia*
Risk Factors*
Tissue Donors
Transplant Recipients
Trimethoprim, Sulfamethoxazole Drug Combination
Antilymphocyte Serum
Trimethoprim, Sulfamethoxazole Drug Combination

Figure

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  Fig. 1 Cumulative incidence of Pneumocystis jirovecii pneumonia (PJP) infection after renal transplantation.

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