<i>Pneumocystis jirovecii</i> pneumonia 13 years post renal transplant following a recurrent cytomegalovirus infection

Iqbal, Ahmar; Lim, Soo Kun; Ng, Kok Peng; Tan, Li; Chong, Yip-Boon; Keng, Tee Chau

doi:10.1111/j.1399-3062.2012.00738.x

Cited by 14 publications

(10 citation statements)

References 20 publications

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“…Finally, we observed an increased incidence of pneumocystis and pulmonary aspergillosis among cases. This observation has been documented in previous reports( 26 , 27 ) and can be the result of an immunosuppressive state induced by CMV infection. The retrospective nature of our data precluded further investigation of this hypothesis.…”

Section: Discussionsupporting

confidence: 85%

Risk factors for cytomegalovirus disease in seropositive renal transplant recipients; a single-center case-controlled study

Navarro-Rodríguez¹,

Herrera-Muñoz²,

Castro³

et al. 2017

J Nephropathol

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Background: Risk factors for cytomegalovirus (CMV) disease in renal transplant recipients have been evaluated in industrialized countries with relatively low CMV seroprevalence. Objectives: We aimed to determine which factors are related to this illness in a high CMV seroprevalence country. Patients and Methods: A case-control study was performed with data from a 5-year follow-up of 260 kidney transplant recipients at our center. Odds ratios were calculated using the Mantel-Haenszel method. Results: A total of 25 cases of CMV disease occurred during the study period. Recipient age greater than 55 years old (odds ratio: 4.95, 95% CI: 1.44–17.0) and use of thymoglobulin (odds ratio: 4.84; 95% CI: 1.10–21.39) were the only independent predictors for CMV disease. There was not any relationship between the previous serologic status of both donor and receptor and the occurrence of CMV disease. We did not observe any association between the immunosuppressive regimens and CMV disease, except for thymoglobulin. Conclusions: Only recipient age and thymoglobulin administration were related to CMV disease. Further studies are needed to determine if prophylactic treatment confers clinical benefit in this subset of patients.

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Section: Discussionsupporting

confidence: 85%

Risk factors for cytomegalovirus disease in seropositive renal transplant recipients; a single-center case-controlled study

Navarro-Rodríguez¹,

Herrera-Muñoz²,

Castro³

et al. 2017

J Nephropathol

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“…Some single‐center studies showed pneumocystis pneumonia (PCP) is a rare disease in SOT recipients and casted doubt on the requirement for prophylaxis . However, in our study, 12% of IFI episodes were pneumocystis pneumonia (PCP).…”

Section: Discussionmentioning

confidence: 99%

Incidence and outcomes of invasive fungal infection among solid organ transplant recipients: A population‐based cohort study

Hosseini-Moghaddam

Ouedraogo²,

Naylor³

et al. 2020

Transplant Infectious Dis

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Background Invasive fungal infection (IFI) in solid organ transplant (SOT) recipients is associated with significant morbidity and mortality. The long‐term probability of post‐transplant IFI is poorly understood. Methods We conducted a population‐based cohort study using linked administrative healthcare databases from Ontario, Canada, to determine the incidence rate; 1‐, 5‐, and 10‐year cumulative probabilities of IFI; and post‐IFI all‐cause mortality in SOT recipients from 2002 to 2016. We also determined post‐IFI, death‐censored renal allograft failure. Results We included 9326 SOT recipients (median follow‐up: 5.35 years). Overall, the incidence of IFI was 8.3 per 1000 person‐years. The 1‐year cumulative probability of IFI was 7.4% for lung, 5.4% for heart, 1.8% for liver, 1.2% for kidney‐pancreas, and 1.1% for kidney‐only allograft recipients. Lung transplant recipients had the highest incidence rate and 10‐year probability of IFI: 43.0 per 1000 person‐years and 26.4%, respectively. The 1‐year all‐cause mortality rate after IFI was 34.3%. IFI significantly increased the risk of mortality in SOT recipients over the entire follow‐up period (hazard ratio: 6.50, 95% CI: 5.69‐7.42). The 1‐year probability of death‐censored renal allograft failure after IFI was 9.8%. Conclusion Long‐term cumulative probability of IFI varies widely among SOT recipients. Lung transplantation was associated with the highest incidence of IFI with considerable 1‐year all‐cause mortality.

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“…This result is in agreement with that of previous studies 17, 21 . CMV is known to modify host immune responses by various mechanisms, suppressing helper T-cell and antigen presenting cell functions 22 . Therefore, CMV infection is both a marker of an immunocompromised state and has, itself, an immunosuppressive effect 23 .…”

Section: Discussionmentioning

confidence: 99%

Risk factors for Pneumocystis jirovecii pneumonia (PJP) in kidney transplantation recipients

Lee

Huh

Joo

et al. 2017

Sci Rep

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Pneumocystis jirovecii pneumonia (PJP) is a potentially life-threatening infection that occurs in immunocompromised patients. The aim of this study was to evaluate risk factors for PJP in kidney transplantation recipients. We conducted a retrospective analysis of patient data from 500 consecutive kidney transplants performed at Severance Hospital between April 2011 and April 2014. Eighteen kidney transplantation recipients (3.6%) were diagnosed with PJP. In the univariate analysis, acute graft rejection, CMV infection, use of medication for diabetes mellitus, and lowest lymphocyte count were associated with PJP. Recipients who experienced acute graft rejection (odds ratio [OR] 11.81, 95% confidence interval [CI] 3.06–45.57, P < 0.001) or developed CMV infection (OR 5.42, 95% CI 1.69–17.39, P = 0.005) had high odds of PJP in multivariate analysis. In the acute graft rejection subgroup, patients treated with anti-thymocyte globulin (ATG) had significantly higher odds of PJP (OR 5.25, 95% CI 1.01–27.36, P = 0.006) than those who were not. Our data suggest that acute graft rejection and CMV infection may be risk factors for PJP in kidney transplant patients. The use of ATG for acute graft rejection may increase the risk of PJP.

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Pneumocystis jirovecii pneumonia 13 years post renal transplant following a recurrent cytomegalovirus infection

Cited by 14 publications

References 20 publications

Risk factors for cytomegalovirus disease in seropositive renal transplant recipients; a single-center case-controlled study

Risk factors for cytomegalovirus disease in seropositive renal transplant recipients; a single-center case-controlled study

Incidence and outcomes of invasive fungal infection among solid organ transplant recipients: A population‐based cohort study

Risk factors for Pneumocystis jirovecii pneumonia (PJP) in kidney transplantation recipients

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