Risk of Pneumocystis jiroveci pneumonia in patients long after renal transplantation

Struijk, Geertrude H.; Gijsen, Anton F.; Yong, S. L.; Zwinderman, Aeilko H.; Geerlings, Suzanne E.; Lettinga, Kamilla D.; Pant, Karlijn A.M.I. van Donselaar-van der; Berge, Ineke J. M. ten; Bemelman, Fréderike J.

doi:10.1093/ndt/gfr048

Cited by 62 publications

(80 citation statements)

References 35 publications

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“…During the period of 200 days before PCP, the lymphocyte decrease appeared to be significant from about 50 days before PCP while there was no difference in the lymphocyte count before this date. As reported by Struijk et al, our study showed that lower lymphocyte counts appeared to be a risk factor of PCP in SOT patients (14). Thus, these data suggest that lymphocyte counts may help to guide the indication for chemoprophylaxis in these patients to avoid PCP.…”

Section: Discussionsupporting

confidence: 86%

“…Isolated cases or outbreaks are frequently described in transplant units (9,(28)(29)(30)(31)(32)(33). Historically, rates of PCP pneumonia after SOT were generally around 5-15% (3,13,14). Today, probably due to the generalization of primary prolonged prophylaxis with TMP-SMX, PCP is a relatively rare infection in SOT recipients as most recent studies report lower rates of PCP from 0.3% to 2.6% (23,(34)(35)(36).…”

Section: Discussionmentioning

confidence: 99%

“…Before the institution of routine prophylaxis, the highest risk period for the development of PCP was the first 6 months after transplantation (6-12) with a PCP incidence of about 10% (5-15%) (3,13,14). PCP prophylaxis with trimethoprimsulfamethoxazole (TMP-SMX) has proven highly effective in preventing PCP in SOT recipients (15,16) as it reduces the risk by 91% (17).…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors of Pneumocystis Pneumonia in Solid Organ Recipients in the Era of the Common Use of Posttransplantation Prophylaxis

Iriart

Belval²,

Fillaux³

et al. 2015

American Journal of Transplantation

116

170

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Xavier Iriart, iriart.x@chu-toulouse.fr y Both authors contributed equally. Pneumocystis pneumonia (PCP) in solid organ transplant (SOT) recipients becomes rare in the immediate posttransplantation period thanks to generalized prophylaxis. We aimed to identify the predictive factors for PCP in the era of universal prophylaxis and to propose a strategy for preventing PCP beyond the first year after transplantation. In a retrospective case-control study, 33 SOT cases with PCP diagnosed between 2004 and 2010 were matched with two controls each to identify risk factors for PCP by uniand multivariate analysis. All the patients benefited from 6 months of posttransplantation trimethoprimsulfamethoxazole prophylaxis. Most PCP in SOT patients occurred during the second year posttransplantation (33%). By univariate analysis, age, nonuse of tacrolimus, total and CD4 lymphocyte counts, gammaglobulin concentration and cytomegalovirus (CMV) infection appeared to be PCP risk factors. In the final multivariate analysis, age (adjusted odds ratio [OR] 3.7, 95% confidence interval [CI]: 1.3-10.4), CMV infection (OR: 5.2, 95% CI: 1.8-14.7) and total lymphocyte count (OR: 3.9, 95% CI: 1.4-10.7) were found to be independently associated with PCP. The second year posttransplantation appeared to be the new period of highest risk of PCP. Age, CMV viremia and lymphocytes were the most pertinent predictive criteria to evaluate the risk of PCP in clinical practice.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk Factors of Pneumocystis Pneumonia in Solid Organ Recipients in the Era of the Common Use of Posttransplantation Prophylaxis

Iriart

Belval²,

Fillaux³

et al. 2015

American Journal of Transplantation

116

170

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“…Globally, the epidemiology of this disease has always been difficult to study (21,23,28,29), mainly due to the lack of easy-to-perform methods of culture and because alternative powerful and informative techniques have not been available in all microbiology laboratories (30). However, MLST is now used widely to investigate nosocomial PCP outbreaks and is generally considered the gold standard (6,10,11,18,31).…”

Section: Discussionmentioning

confidence: 99%

Epidemiological Outbreaks of Pneumocystis jirovecii Pneumonia Are Not Limited to Kidney Transplant Recipients: Genotyping Confirms Common Source of Transmission in a Liver Transplantation Unit

et al. 2016

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j Over a 5-month period, four liver transplant patients at a single hospital were diagnosed with Pneumocystis jirovecii pneumonia (PCP). This unusually high incidence was investigated using molecular genotyping. Bronchoalveolar lavage fluids (BALF) obtained from the four liver recipients diagnosed with PCP were processed for multilocus sequence typing (MLST) at three loci (SOD, mt26s, and CYB). Twenty-four other BALF samples, which were positive for P. jirovecii and collected from 24 epidemiologically unrelated patients with clinical signs of PCP, were studied in parallel by use of the same method. Pneumocystis jirovecii isolates from the four liver recipients all had the same genotype, which was different from those of the isolates from all the epidemiologically unrelated individuals studied. These findings supported the hypothesis of a common source of contamination or even cross-transmission of a single P. jirovecii clone between the four liver recipients. Hospitalization mapping showed several possible encounters between these four patients, including outpatient consultations on one particular date when they all possibly met. This study demonstrates the value of molecular genotyping of P. jirovecii isolated from clinical samples for epidemiological investigation of PCP outbreaks. It is also the first description of a common source of exposure to a single P. jirovecii clone between liver transplant recipients and highlights the importance of prophylaxis in such a population.

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“…3,8 To improve outcomes of RTRs, previous studies have identified PJP risk factors in RTRs including poor renal function, prior allograft rejection, mycophenolate mofetil use, and persistent lymphocytopenia. [9][10][11] Moreover, to reduce PJP mortality rate in RTRs, it is crucial to identify determinants of PJP mortality that have not been investigated before. Meanwhile, for patients with PJP, KDIGO recommends reducing the amount of immunosuppressive medications.…”

Section: Introductionmentioning

confidence: 99%

Aggressive Immunosuppressant Reduction and Long-Term Rejection Risk in Renal Transplant Recipients with Pneumocystis jiroveci Pneumonia

Yang¹,

Shih²,

Wu³

et al. 2012

Exp Clin Transplant

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Objectives: Pneumocystis jiroveci pneumonia is a rare but lethal complication in renal transplant recipients. Dose reduction of immunosuppressive agents in such situations is recommended, but its quantity and safety are unclear. Materials and Methods: From January 2001 to January 2011, twenty of one thousand forty-six renal transplant recipients in a single center developed Pneumocystis jiroveci pneumonia, which was diagnosed by the Giemsa and Gomori methenamine silver stains from a specimen of bronchoalveolar lavage. Results: We found that timing of the first immunosuppressant reduction of the Pneumocystis jiroveci pneumonia survivor (mean, 1.4 days after admission) was significantly earlier than that of the deceased patient (mean, 5.1 days after admission). Logistic regression analysis indicated that for those whose immunosuppressants were reduced more aggressively (either 1 of the immunosuppressants was reduced by more than 50% within 2 days of hospitalization) were significantly more likely to survive (mortality risk, OR, 0.074 [95% CI, 0.01-0.84]; P = .035). In addition, none of the survivors developed acute rejection or allograft necrosis during a mean follow-up of 2 years. Conclusions: Dosage reduction of immunosuppressive agents in renal transplant recipients with Pneumocystis jiroveci pneumonia should be prompt and sufficient. Aggressive immunosuppressant dosage reduction is safe in such circumstance and is associated with minimal risk of in-hospital and long-term acute allograft rejection.

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Risk of Pneumocystis jiroveci pneumonia in patients long after renal transplantation

Abstract: Long-term prophylactic therapy for PCP may be indicated for RTR with persistent severe lymphocytopaenia.

Cited by 62 publications

References 35 publications

Risk Factors of Pneumocystis Pneumonia in Solid Organ Recipients in the Era of the Common Use of Posttransplantation Prophylaxis

Risk Factors of Pneumocystis Pneumonia in Solid Organ Recipients in the Era of the Common Use of Posttransplantation Prophylaxis

Epidemiological Outbreaks of Pneumocystis jirovecii Pneumonia Are Not Limited to Kidney Transplant Recipients: Genotyping Confirms Common Source of Transmission in a Liver Transplantation Unit

Aggressive Immunosuppressant Reduction and Long-Term Rejection Risk in Renal Transplant Recipients with Pneumocystis jiroveci Pneumonia

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