*Purpose: In the era of prophylaxis, pneumocystis jirovecii pneumonia (PJP) is a rare post-transplant complication, particularly among kidney transplant recipients (KTR). Cases of PJP in solid organ transplant (SOT) have often described coinfection with cytomegalovirus (CMV), lymphocyte-depleting agents for acute rejection (AR), and lymphopenia as significant risk factors for PJP beyond 6-12 months post-SOT.

*Methods: Retrospective case series of KTR at a single transplant center with a confirmed diagnosis of PJP by cytology obtained through bronchoscopy. Transplant, clinical, and PJP infection characteristics, treatment, and outcomes are described below.

*Results: Six cases of PJP in KTR occurred within 2 months at our institution. The majority (67%) were female and the median age at PJP diagnosis was 59 years old (y/o). Median time from transplant to PJP infection was 5.5 years and none of the patients were on PJP prophylaxis. All but 1 patient required treatment with a second line agent due to trimethoprim-sulfamethoxazole (TMP/SMX) intolerance. Half of the patients had AR within the previous 12 months; however, none received lymphocyte-depleting agents. All 6 patients had lymphopenia at diagnosis, 1 patient had coinfection with CMV, 1 required ICU admission, and all survived to hospital discharge.

*Conclusions: Our series highlights the need for strict adherence to PJP prophylaxis and suggests reinitiation of PJP prophylaxis after treatment of AR with corticosteroids, even in a non-PJP era.

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