Risk of Pneumocystis jirovecii Pneumonia among Solid Organ Transplant Recipients: A Population-Based Study

Abstract

Few studies have comprehensively investigated the occurrence of Pneumocystis jirovecii pneumonia (PJP) among solid organ transplant (SOT) recipients. This study investigated the risk of PJP after organ transplantation. Each patient who underwent SOT was propensity-score-matched with four non-SOT individuals in terms of sex, age, insured salary, urbanization of residence, comorbidities, and year of enrollment. When considering the 3-year follow-up, the patients who had undergone SOT were at higher risk of PJP, with the adjusted odds ratio (aOR) being 17.18 (95% confidence interval (CI): 8.80–33.53). Furthermore, SOT recipients were also at higher PJP risk than the patients without SOT at 6 months, 1 year, and 2 years, with the aOR being 22.64 (95% CI: 7.53–68.11), 26.19 (95% CI: 9.89–69.37), and 23.06 (95% CI: 10.23–51.97), respectively. Patients comorbid with HIV infection, hematological malignancies, or vasculitis were at higher risk (aOR = 59.08, 95% CI = 20.30–171.92), (aOR = 11.94, 95% CI = 5.36–26.61), and (aOR = 21.72, 95% CI = 2.41–195.81), respectively. The recipients of SOT were at higher risk of PJP, and PJP can develop at any stage after transplantation. SOT recipients comorbid with HIV, hematologic malignancies, or vasculitis were at higher PJP risk.

Pneumocystis jirovecii in solid organ transplant recipients: updates in epidemiology, diagnosis, treatment, and prevention

“…There is a single case--control study in heart transplant recipients demonstrating improved mortality outcomes with combination therapy (20%) compared to TMP/SMX monotherapy (33.3%) [57]. The novel antifungal agent, ibrexafungerp, has also been shown to have activity against Pneumocystis in animal models [58].…”

Clinical characteristics and risk factors for late‐onset pneumocystis jirovecii pneumonia in kidney transplantation recipients

“…However, with these prophylactic measures, people found that the peak of PJP occurrence changed and was postponed. PJP can occur rather late after organ transplantation 13,14 . Then, in 2019, The American Society of Transplantation recommended prophylaxis with daily or double doses of three times weekly TMP‐SMX for 6–12 months 15 …”

“…PJP can occur rather late after organ transplantation. 13,14 Then, in 2019, The American Society of Transplantation recommended prophylaxis with daily or double doses of three times weekly TMP-SMX for 6-12 months. 15 To avoid PJP, the risk factors should be identified and prevented if possible.…”

Bone Loss after Solid Organ Transplantation: A Review of Organ-Specific Considerations

“…Organ dysfunction is associated with pronounced adverse effects on skeletal integrity, as evidenced by marked decreases in bone mineral density (BMD), deterioration of microstructural quality, and a consequent reduction in biomechanical strength, cumulatively increasing the risk of osteoporotic fractures even before transplantation [8]. The most precipitous decline in BMD typically occurs within the first 6 to 12 months following transplantation, marked by a striking surge in fracture risk [9,10]. Recent research underscores the gravity of this issue, revealing that the hazard ratio for osteoporosis after solid organ transplantation is approximately five times higher than that for non-transplant patients [9].…”

“…The most precipitous decline in BMD typically occurs within the first 6 to 12 months following transplantation, marked by a striking surge in fracture risk [9,10]. Recent research underscores the gravity of this issue, revealing that the hazard ratio for osteoporosis after solid organ transplantation is approximately five times higher than that for non-transplant patients [9]. Several key risk factors contribute to the development of transplantation osteoporosis, with pre-transplant bone disease and post-transplant immunosuppressive therapy emerging as the primary culprit [7,11,12].…”