Experience with a six‐month regimen of Pneumocystis pneumonia prophylaxis in 122 HIV‐positive kidney transplant recipients

Abstract

Pneumocystis jiroveci remains an important respiratory pathogen in immunocompromised individuals. Historically, without prophylaxis, the incidence of Pneumocystis pneumonia (PCP) in HIV-negative solid organ transplant (SOT) recipients ranged from 5% to 15%. 1-3 PCP results in significant disease burden in SOT recipients, with mortality rates ranging from 5% to 50% depending on the transplanted organ. 4 Trimethoprim-sulfamethoxazole (TMP/SMX) remains the drug of choice for primary prophylaxis. 5 Atovaquone, dapsone, and pentamidine are reasonable alternatives for those with intolerance to TMP/ SMX. Kidney transplant recipients are most at risk for PCP during periods of heightened immunosuppression. This is usually during the first 6 to 12 months after transplant and during treatment for acute rejection. For HIV-negative recipients, the European guidelines recommend at least 4 months of PCP prophylaxis after transplant. 6 The Kidney Disease Improving Global Outcomes recommends 3 to 6 months of routine prophylaxis. 7 With the widespread use of prophylaxis, PCP is almost non-existent in the first year after kidney transplant among HIV-negative recipients. It is now more commonly seen in the second post-transplant year or even more delayed, occurring 6 to 10 years later. 4,[8][9][10] The global incidence of PCP during