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Pneumocystis jirovecii pneumonia in solid organ transplant recipients: a descriptive analysis for the Swiss Transplant Cohort
Author(s) -
Neofytos Dionysios,
Hirzel Cedric,
Boely Elsa,
Lecompte Thanh,
Khanina,
Mueller Nicolas J.,
Boggian Katia,
Cusini Alexia,
Manuel Oriol,
Delden Christian
Publication year - 2018
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.12984
Subject(s) - medicine , incidence (geometry) , pneumocystis pneumonia , cohort , pneumocystis jirovecii , complication , surgery , pneumonia , physics , optics
Abstract Background Descriptive data on Pneumocystis jirovecii pneumonia ( PJP ) in solid organ transplant recipients ( SOT r) in the era of routine Pneumocystis ‐prophylaxis are lacking. Methods All adult SOT r between 2008 and 2016 were included. PJP was diagnosed based on consensus guidelines. Early‐onset PJP was defined as PJP within the first‐year‐post‐transplant. Results 41/2842 SOT r (1.4%) developed PJP (incidence rate: 0.01/1000 person‐days) at a mean of 493‐days post‐transplant: 21 (51.2%) early vs 20 (48.8%) late‐onset PJP . 2465 (86.7%) SOT r received Pneumocystis ‐prophylaxis for a mean 316 days. PJP incidence was 0.001% and 0.003% (log‐rank < 0.001) in SOT r with and without Pneumocystis ‐prophylaxis, respectively. PJP was an early event in 10/12 (83.3%) SOT r who did not receive Pneumocystis ‐prophylaxis and developed PJP , compared to those patients who received prophylaxis (11/29, 37.9%; P ‐value: 0.008). Among late‐onset PJP patients, most cases (13/20, 65%) were observed during the 2nd year post‐transplant. Age ≥65 years ( OR : 2.4, P ‐value: 0.03) and CMV infection during the first 6 months post‐ SOT ( OR : 2.5, P ‐value: 0.006) were significant PJP predictors, while Pneumocystis ‐prophylaxis was protective for PJP ( OR : 0.3, P ‐value: 0.006) in the overall population. Most patients (35, 85.4%) were treated with trimethoprim‐sulfamethoxazole for a mean 20.6 days. 1‐year mortality was 14.6%. Conclusions In the Pneumocystis ‐prophylaxis‐era, PJP remains a rare post‐transplant complication. Most cases occurred post‐ PJP ‐prophylaxis‐discontinuation, particularly during the second‐year‐post‐transplant. Additional research may help identify indications for Pneumocystis ‐prophylaxis prolongation.