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Pneumocystis jirovecii pneumonia in solid organ transplant recipients: a descriptive analysis for the Swiss Transplant Cohort

Dionysios Neofytos, Cédric Hirzel, Elsa Boely, Thanh Lecompte, Nina Khanna, Nicolas J Mueller, Katia Boggian, Alexia Cusini, Oriol Manuel, Christian Van Delden & Swiss Transplant Cohort Study

abstract

BACKGROUND
Descriptive data on Pneumocystis jirovecii pneumonia (PJP) in solid organ transplant recipients (SOTr) in the era of routine Pneumocystis-prophylaxis are lacking.

METHODS
All adult SOTr between 2008-2016 were included. PJP was diagnosed based on consensus guidelines. Early-onset PJP was defined as PJP within the 1st-year-post-transplant.

RESULTS
41/2842 SOTr (1.4%) developed PJP (incidence rate: 0.01/1000 person-days) at a mean of 493-days post-transplant: 21 (51.2%) early vs 20 (48.8%) late-onset PJP. 2465 (86.7%) SOTr received Pneumocystis-prophylaxis for a mean 316 days. PJP incidence was 0.001% and 0.003% (log-rank<0.001) in SOTr with and without Pneumocystis-prophylaxis, respectively. PJP was an early event in 10/12 (83.3%) SOTr who did not receive Pneumocystis-prophylaxis and developed PJP, compared to those patients who received prophylaxis (11/29, 37.9%; P-value: 0.008). Among late-onset PJP patients, most cases (13/20, 65%) were observed during the 2 year post-transplant. Age ≥65 years (OR: 2.4, P-value: 0.03) and CMV infection during the first 6 months post-SOT (OR: 2.5, P-value: 0.006) were significant PJP predictors, while Pneumocystis-prophylaxis was protective for PJP (OR: 0.3, P-value: 0.006) in the overall population. Most patients (35, 85.4%) were treated with trimethoprim-sulfamethoxazole for a mean 20.6 days. 1-year mortality was 14.6%.

CONCLUSIONS
In the Pneumocystis-prophylaxis-era, PJP remains a rare post-transplant complication. Most cases occurred post-PJP-prophylaxis-discontinuation, particularly during the 2 -year-post-transplant. Additional research may help identify indications for Pneumocystis-prophylaxis prolongation. This article is protected by copyright. All rights reserved.
   
citation Neofytos D, Hirzel C, Boely E, Lecompte T, Khanna N, Mueller N J, Boggian K, Cusini A, Manuel O, van Delden C, Swiss Transplant Cohort Study . Pneumocystis jirovecii pneumonia in solid organ transplant recipients: a descriptive analysis for the Swiss Transplant Cohort. Transpl Infect Dis 2018;e12984.
   
type journal paper/review (English)
date of publishing 28-08-2018
journal title Transpl Infect Dis
ISSN electronic 1399-3062
pages e12984
PubMed 30155950
DOI 10.1111/tid.12984