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

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Title: Pneumocystis jirovecii pneumonia in solid organ transplant recipients: a descriptive analysis for the Swiss Transplant Cohort.
Authors: Neofytos, D., Hirzel, C., Boely, E., Lecompte, T., Khanna, N., Mueller, N.J., Boggian, K., Cusini, A., Manuel, O., van Delden, C.
Contributors: Swiss Transplant Cohort Study, Amico, P., Aubert, J.D., Banz, V., Beldi, G., Benden, C., Berger, C., Binet, I., Bochud, P.Y., Boëly, E., Bucher, H., Carell, T., Catana, E., Chalandon, Y., de Geest, S., de Rougemont, O., Dickenmann, M., Duchosal, M., Elkrief, L., Fehr, T., Ferrari-Lacraz, S., Garzoni, C., Soccal, P.G., Gaudet, C., Giostra, E., Golshayan, D., Hadaya, K., Halter, J., Heim, D., Hess, C., Hillinger, S., Hirsch, H.H., Hofbauer, G., Huynh-Do, U., Immer, F., Klaghofer, R., Koller, M., Laesser, B., Lehmann, R., Lovis, C., Majno, P., Marti, H.P., Martin, P.Y., Meylan, P., Mohacsi, P., Morel, P., Mueller, U., Mueller-McKenna, H., Müller, A., Müller, T., Müllhaupt, B., Pascual, M., Passweg, J., Posfay-Barbe, K., Rick, J., Roosnek, E., Rosselet, A., Rothlin, S., Ruschitzka, F., Schanz, U., Schaub, S., Schnyder, A., Seiler, C., Sprachta, J., Stampf, S., Steiger, J., Stirnimann, G., Toso, C., Venetz, J.P., Villard, J., Wick, M., Wilhelm, M., Yerly, P.
Publication Year: 2025
Collection: Université de Lausanne (UNIL): Serval - Serveur académique lausannois
Subject Terms: Adult, Aged, Anti-Bacterial Agents/therapeutic use, Antibiotic Prophylaxis/methods, Antibiotic Prophylaxis/standards, Female, Humans, Incidence, Male, Middle Aged, Mortality, Organ Transplantation/adverse effects, Pneumocystis carinii/isolation & purification, Pneumonia, Pneumocystis/drug therapy, Pneumocystis/epidemiology, Pneumocystis/microbiology, Pneumocystis/prevention & control, Practice Guidelines as Topic, Prospective Studies, Switzerland/epidemiology, Treatment Outcome, Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use, Young Adult, Epidemiology, Pneumocystis jirovecii pneumonia, Solid organ transplant recipients
Description: Descriptive data on Pneumocystis jirovecii pneumonia (PJP) in solid organ transplant recipients (SOTr) in the era of routine Pneumocystis-prophylaxis are lacking. All adult SOTr between 2008 and 2016 were included. PJP was diagnosed based on consensus guidelines. Early-onset PJP was defined as PJP within the first-year-post-transplant. 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 2nd 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%. In the Pneumocystis-prophylaxis-era, PJP remains a rare post-transplant complication. Most cases occurred post-PJP-prophylaxis-discontinuation, particularly during the second-year-post-transplant. Additional research may help identify indications for Pneumocystis-prophylaxis prolongation.
Document Type: article in journal/newspaper
File Description: application/pdf
Language: English
ISSN: 1399-3062
Relation: Transplant Infectious Disease; https://iris.unil.ch/handle/iris/148028; serval:BIB_B857EB67958D; 000452406900015
DOI: 10.1111/tid.12984
Availability: https://iris.unil.ch/handle/iris/148028
https://doi.org/10.1111/tid.12984
Accession Number: edsbas.FFF82CF
Database: BASE
Description
Abstract:Descriptive data on Pneumocystis jirovecii pneumonia (PJP) in solid organ transplant recipients (SOTr) in the era of routine Pneumocystis-prophylaxis are lacking. All adult SOTr between 2008 and 2016 were included. PJP was diagnosed based on consensus guidelines. Early-onset PJP was defined as PJP within the first-year-post-transplant. 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 2nd 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%. In the Pneumocystis-prophylaxis-era, PJP remains a rare post-transplant complication. Most cases occurred post-PJP-prophylaxis-discontinuation, particularly during the second-year-post-transplant. Additional research may help identify indications for Pneumocystis-prophylaxis prolongation.
ISSN:13993062
DOI:10.1111/tid.12984