Distinct Clinical and Laboratory Patterns of Pneumocystis jirovecii Pneumonia in Renal Transplant Recipients

Abstract

Late post-transplant Pneumocystis jirovecii pneumonia (PcP) has been reported in many renal transplant recipients (RTRs) centers using universal prophylaxis. Specific features of PcP compared to other respiratory infections in the same population are not well reported. We analyzed clinical, laboratory, administrative and radiological data of all confirmed PcP cases between January 2009 and December 2014. To identify factors specifically associated with PcP, we compared clinical and laboratory data of RTRs with non-PcP. Over the study period, 36 cases of PcP were identified. Respiratory distress was more frequent in PcP compared to non-PcP (tachypnea: 59%, 20/34 vs. 25%, 13/53, p = 0.0014; dyspnea: 70%, 23/33 vs. 44%, 24/55, p = 0.0181). In contrast, fever was less frequent in PcP compared to non-PcP pneumonia (35%, 11/31 vs. 76%, 42/55, p = 0.0002). In both cohorts, total lymphocyte count and serum sodium decreased, whereas lactate dehydrogenase (LDH) increased at diagnosis. Serum calcium increased in PcP and decreased in non-PcP. In most PcP cases (58%, 21/36), no formal indication for restart of PcP prophylaxis could be identified. Potential transmission encounters, suggestive of interhuman transmission, were found in 14/36, 39% of patients. Interhuman transmission seems to contribute importantly to PcP among RTRs. Hypercalcemia, but not elevated LDH, was associated with PcP when compared to non-PcP.

Risk factors for Pneumocystis jirovecii pneumonia after kidney transplantation: A systematic review and meta‐analysis

“…The additional 73 studies were evaluated furtherly through a full‐text review. Ultimately, a total of 27 retrospective studies published between 1995 and 2022 were included in the meta‐analysis 6,8,14–38 . Among them, 15 studies are from Europe, 6 are from Asia, 5 are from the Americas, and 1 is from Oceania.…”

“…Ultimately, it was found that eight factors are associated with PJP occurrence: age at transplantation, ABO‐incompatibility, acute rejection, CMV infection, BK viremia, anti‐PJP prophylaxis, eGFR and lymphocyte count. Some studies have investigated risk factors for PJP before, such as age, CMV infection, transplant rejection episodes, dialysis time and Tacrolimus dose 7,9,14–38 . However, these conclusions differ, which could be attributed to the fact that people are from different regions of the world.…”