Risk factors for Pneumocystis jirovecii pneumonia in kidney transplant recipients and appraisal of strategies for selective use of chemoprophylaxis
- 21 June 2011
- journal article
- Published by Wiley in Transplant Infectious Disease
- Vol. 13 (6), 559-569
- https://doi.org/10.1111/j.1399-3062.2011.00645.x
Abstract
M.G.J. de Boer, F.P. Kroon, S. le Cessie, J.W. de Fijter, J.T. van Dissel. Risk factors for Pneumocystis jirovecii pneumonia in kidney transplant recipients and appraisal of strategies for selective use of chemoprophylaxis.Transpl Infect Dis 2011: 13: 559–569. All rights reserved Risk stratification-based duration of trimethoprim-sulfamethoxazole (TMP-SMX) chemoprophylaxis to prevent Pneumocystis pneumonia (PCP) in kidney transplant recipients is not a universally adapted strategy and supporting evidence-based sources are limited. We performed a large retrospective study to identify risk factors for PCP in kidney transplant recipients and to define parameters for use in clinical prophylaxis guidelines. Fifty consecutive patients with confirmed PCP and 2 time-matched controls per case were enrolled. All patients were participants of the kidney transplantation program of the Leiden University Medical Center, a tertiary care hospital in the Netherlands. Potential risk factors were compared between groups by uni- and multivariate matched analyses. At transplantation, age >55 years (adjusted odds ratio [OR] 2.7, 95% confidence interval [CI] 1.3–5.9) and not receiving basiliximab induction therapy (adjusted OR 4.3, 95% CI 1.1–17.1) predicted development of PCP. In the final multivariate analysis, only cytomegalovirus infection (adjusted OR 3.0, 95% CI 1.2–7.9) and rejection treatment (adjusted OR 5.8, 95% CI 1.9–18) were found to be independently associated with PCP. Using the variables identified by the multivariate analyses, effects of different hypothetical chemoprophylaxis strategies were systematically evaluated. Exploring different scenarios showed that chemoprophylaxis in the first 6 months for all renal transplant patients – and during the first year posttransplantation for patients >55 years of age or those treated for rejection – would result in very low PCP incidence and optimal avoidance of TMP-SMX toxicity. The results provide a rationale for further prospective study on targeted provision of chemoprophylaxis to prevent PCP in kidney transplant patients.Keywords
This publication has 27 references indexed in Scilit:
- High Prevalence of Dihydropteroate Synthase Mutations in Pneumocystis jirovecii Isolated from Patients with Pneumocystis Pneumonia in South AfricaJournal of Clinical Microbiology, 2010
- Trimethoprim-sulfamethoxazole induced acute interstitial nephritis in renal allografts; clinical course and outcomeClinical Nephrology, 2009
- Infectious Complications of Antilymphocyte Therapies in Solid Organ TransplantationClinical Infectious Diseases, 2009
- Prevention of toxoplasmosis in transplant patientsClinical Microbiology & Infection, 2008
- Cytomegalovirus-specific T-cell responses and viral replication in kidney transplant recipientsJournal of Translational Medicine, 2008
- Critical care management and outcome of severe Pneumocystis pneumonia in patients with and without HIV infectionCritical Care, 2008
- Molecular Evidence ofPneumocystisTransmission in Pediatric Transplant UnitEmerging Infectious Diseases, 2005
- Pneumocystis jiroveciiin General PopulationEmerging Infectious Diseases, 2005
- THE RISKS AND BENEFITS OF LOW-DOSE COTRIMOXAZOLE PROPHYLAXIS FOR PNEUMOCYSTIS PNEUMONIA IN RENAL TRANSPLANTATIONTransplantation, 1989
- Successful Chemoprophylaxis forPneumocystis cariniiPneumonitisThe New England Journal of Medicine, 1977