A Multicenter Case-control Study of the Effect of Acute Rejection and Cytomegalovirus Infection on Pneumocystis Pneumonia in Solid Organ Transplant Recipients
- 13 August 2018
- journal article
- research article
- Published by Oxford University Press (OUP) in Clinical Infectious Diseases
- Vol. 68 (8), 1320-1326
- https://doi.org/10.1093/cid/ciy682
Abstract
Pneumocystis pneumonia (PCP) is associated with morbidity and mortality in solid organ transplant (SOT) recipients. In this case-control study, we determined the association between post-transplant PCP and 3 variables: cytomegalovirus infection, allograft rejection and prophylaxis. Eight transplantation centers participated. For each case (SOT recipient with PCP), 3–5 controls (SOT recipients without PCP) were included. Controls were matched to the cases based on transplant center, type of allograft and date of transplantation (± 6 months). We enrolled 53 cases and 209 controls. Transplant types included kidney (n=198), heart (n=30), liver (n=15), kidney-pancreas (n=14) and lung (n=5). PCP occurred beyond 12 months after transplantation in 43 (81.1%) cases. Thirty-four cases (64.1%) required admission to ICU and 28 (52.8%) had mechanical ventilation. Allograft failure occurred in 20 (37.7%) cases and 14 (26.9%) died. No patient developed PCP prophylaxis breakthrough. The proportion of female sex (p= 0.009), kidney dysfunction (p=0.001), cardiac diseases (p=0.005), diabetes mellitus (p=0.03), allograft rejection (p=0.001), CMV infection (p=0.001) and severe lymphopenia (p=0.001) were significantly higher in cases. In logistic regression model, CMV infection (adjusted OR: 4.6, 95% CI: 2.0–10.5) and allograft rejection (adjusted OR: 3.0, 95% CI: 1.5- 6.1) significantly increased the likelihood of PCP. PCP was mostly a late-onset disease occurring after complete course of prophylaxis particularly among patients with CMV infection or allograft rejection. PCP is associated with significant allograft loss. Extended prophylaxis targeting recipients with allograft rejection or CMV infection may reduce the risk of PCP.Keywords
This publication has 35 references indexed in Scilit:
- Pneumocystis Pneumonia in Solid Organ TransplantationAmerican Journal of Transplantation, 2013
- Nosocomial Pneumocystis jirovecii Pneumonia: Lessons From a Cluster in Kidney Transplant RecipientsTransplantation, 2011
- Clinical characteristics of Pneumocystis pneumonia in non-HIV patients and prognostic factors including microbiological genotypesBMC Infectious Diseases, 2011
- Pneumocystis jirovecii pneumonia in renal transplant recipients occurring after discontinuation of prophylaxis: a case–control studyClinical Microbiology & Infection, 2010
- Special Issue: KDIGO Clinical Practice Guideline for the Care of Kidney Transplant RecipientsAmerican Journal of Transplantation, 2009
- Outbreak of Pneumocystis jiroveci Pneumonia in Renal Transplant Recipients: P. jiroveci Is Contagious to the Susceptible HostTransplantation, 2009
- Analysis of USRDS: Incidence and Risk Factors for Pneumocystis jiroveci PneumoniaTransplantation, 2009
- Late onset Pneumocystis pneumonia in renal transplantation after long‐term immunosuppression with belataceptTransplant Infectious Disease, 2009
- Should Prophylaxis for Pneumocystis carinii Pneumonia in Solid Organ Transplant Recipients Ever Be Discontinued?Clinical Infectious Diseases, 1999
- Pneumocystis carinii Pneumonia in Renal-Transplant Recipients Treated with Cyclosporine and SteroidsThe Journal of Infectious Diseases, 1984