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Low incidence of P neumocystis jirovecii pneumonia in an unprophylaxed liver transplant cohort
Author(s) -
Sarwar S.,
Carey B.,
Hegarty J.E.,
McCormick P.A.
Publication year - 2013
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12117
Subject(s) - medicine , incidence (geometry) , cohort , case fatality rate , bronchoalveolar lavage , pneumonia , histopathology , gastroenterology , surgery , liver transplantation , transplantation , pathology , epidemiology , lung , physics , optics
Background Liver transplant recipients are managed with a range of immunosuppressive regimens that place them at heightened risk of life‐threatening opportunistic infections such as P neumocystis jirovecii pneumonia ( PJP ). No routine PJP prophylaxis is used at out institution. We reviewed the incidence of PJP in this cohort of unprophylaxed liver transplant recipients. Methods We examined all liver transplants performed between J anuary 2000 and J anuary 2012 in I reland's N ational L iver T ransplant C entre, S t. V incent's U niversity H ospital, D ublin. Cases were identified through a computerized database and through the histopathology and microbiology registration system. The diagnosis of PJP was confirmed by identification of P neumocystis cysts in bronchoalveolar lavage ( BAL ) fluid or on autopsy specimens using G rocott– G omori methenamine‐silver nitrate or modified W right– G iemsa staining methods. Results During the study period, 687 liver transplants were performed. We found 7 cases of PJP with an incidence rate of 0.84 per 1000 person transplant years. Five cases occurred within 12 months of transplant with 2 cases occurring at 56 and 60 months, respectively. Two cases were diagnosed at postmortem; 1 previously had negative cytology from BAL , while the other could not be bronchoscoped because of rapid deterioration in the clinical condition. Three of the 5 treated patients died. Conclusions The incidence of PJP in this cohort was very low, but the case fatality rate was high. Two cases occurred well after the usual recommended period of prophylaxis. In institutions with a very low risk of infection, targeted rather than universal prophylaxis may be reasonable.