Should Prophylaxis for Pneumocystis carinii Pneumonia in Solid Organ Transplant Recipients Ever Be Discontinued?

Gordon, Steven M.; LaRosa, Steven P.; Kalmadi, Sujith; Arroliga, Alejandro C.; Avery, Robin K.; Truesdell-LaRosa, Laura; Longworth, David L.

doi:10.1086/515126

Cited by 170 publications

(138 citation statements)

References 34 publications

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“…Currently, because of universal prophylaxis during the first 6-12 months after transplantation, this infection is now rare and the overall incidence rate of P. jiroveci pneumonia (PCP) in kidney transplant recipients is 0.8 case per 1000 person after completion of 1 year of prophylaxis (88). PCP is associated with a 29%-50% mortality rate in kidney transplant recipients (89).…”

Section: P Jiroveci Infectionmentioning

confidence: 99%

Common Infections in Kidney Transplant Recipients

Karuthu¹,

Blumberg

2012

Clinical Journal of the American Society of Nephrology

211

148

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SummaryInfections are a major cause of morbidity and mortality in kidney transplant recipients. To some extent, these may be preventable. Careful pretransplant screening, immunization, and post-transplant prophylactic antimicrobials may all reduce the risk for post-transplant infection. However, because transplant recipients may not manifest typical signs and symptoms of infection, diagnoses may be confounded. Furthermore, treatment regimens may be complicated by drug interactions and the need to maintain immunosuppression to avoid allograft rejection. This article reviews common post-transplant infections, including prophylactic, diagnostic, and treatment strategies, providing guidance regarding care of kidney transplant patients with infection.

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Section: P Jiroveci Infectionmentioning

confidence: 99%

Common Infections in Kidney Transplant Recipients

Karuthu¹,

Blumberg

2012

Clinical Journal of the American Society of Nephrology

211

148

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“…7 Pneumocystis jiroveci mortality in RTRs is high despite aggressive treatment, and it has been reported to be between 27% and 50%. 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.…”

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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“…It may occur either as sporadic cases or as outbreaks 1,6 . It may be prevented by the prophylactic use of trimethoprim-sulfamethoxazole (TMS) 2,4 .…”

Section: Introductionmentioning

confidence: 99%

Mycophenolate mofetil may protect against Pneumocystis carinii pneumonia in renal transplanted patients

Azevedo

Castro

Paula

et al. 2005

Rev. Inst. Med. trop. S. Paulo

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SUMMARYPneumocystis carinii pneumonia (PCP) is usually prevented in transplanted patients by prophylactic trimethoprimsulfamethoxazol (TMS). Mycophenolate mofetil (MMF) has been shown to have a strong protective effect against PCP in rats. This effect is also suggested in humans by the absence of PCP in patients receiving MMF. After January 1998 MMF has been used with no TMS prophylaxis in renal transplanted patients. In azathioprine (AZA) treated patients TMS prophylaxis was maintained. The incidence of PCP was analyzed in both groups. Data were collected in order to have a minimum 6-month follow-up. Two hundred and seventy-two patients were eligible for analysis. No PCP occurred either in patients under MMF without TMS prophylaxis nor in patients under AZA. MMF may have an effective protective role against PCP as no patient under MMF, despite not receiving TMS coverage, developed PCP. A larger, controlled, trial is warranted to consolidate this information.

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Should Prophylaxis for Pneumocystis carinii Pneumonia in Solid Organ Transplant Recipients Ever Be Discontinued?

Cited by 170 publications

References 34 publications

Common Infections in Kidney Transplant Recipients

Common Infections in Kidney Transplant Recipients

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

Mycophenolate mofetil may protect against Pneumocystis carinii pneumonia in renal transplanted patients

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