Introduction: Pneumocystis pneumonia (PCP) is associated with morbidity and mortality in solid organ transplant patients (SOTs). There are increasing reports of late PCP in SOT patients. We determined the risk factors of PCP in SOTs using a case-control design.

Materials and Methods: 8 transplantation centers participated. Cases were defined as SOT patients with PCP occurring from 2010-2015. For each case, 4 controls (SOT without PCP) were included. Controls were matched to the cases based on transplant center, type of graft and date of transplant (± 6 months).

Logistic regression model was applied to assess the association between the main exposure variables (i.e. rejection, cytomegalovirus (CMV) infection, and prophylaxis) and PCP. In the model, we controlled the effect of covariates: age, sex, retransplantation, smoking, history of diabetes, kidney dysfunction, and congestive heart failure.

Results:

We enrolled 58 cases and 229 controls. Transplant types included kidney (n=221), heart (n=30), kidney-pancreas (n=16), liver (n=15) and lung (n=5).

Late PCP (defined as >=12 months post-transplant) occurred in 47 (83%) patients. Admission to ICU was needed for 34 (58%) patient and 27(47%) had mechanical ventilation. Graft failure after PCP occurred in 21 (36.2%) patients and death in 15 (26.8%) cases. No patient developed prophylaxis breakthrough. When compared to controls, mean age (59.1±14.7 vs 56.4±13.8,p=0.1), organ type (p=0.9), donor type (deceased vs living, p=0.6), retransplantation (p=0.1), ATG induction (p=0.4) and maintenance immunosuppression (p=0.1) were not significantly different. However, female sex (p=0.002), post-transplant kidney dysfunction (p=0.02), CHF (p=0.006), rejection (p=0.01), CMV infection (p=0.001) and severe lymphopenia (p=0.001) were significantly more frequent in cases. In conditional logistic regression model adjusted for confounders, CMV (crude OR=2.77, CI _95%: 1.26, 6.07; adjusted OR: 2.57, CI _95%: 0.98, 6.65) and graft rejection (crude OR=2.91, CI _95%: 1.42, 5.9; adjusted OR: 2.49, CI95%: 1.09, 5.70) increased the risk of PCP.

Conclusion:

Most patients developed late-onset PCP. PCP was associated with significant graft loss and mortality. Extended prophylaxis targeting SOTs with recent allograft rejection or CMV infection may reduce the frequency of PCP.

CITATION INFORMATION: Hosseini-Moghaddam S., Shokoohi M., Singh G., Dufresne S., Jevnikar A., Kabbani D., Cardinal H., Houde I., Hebert M-.J., Shoker A., Prasad G., Humar A., Kumar D. A Multi-Center Analysis of Risk Factors for Pneumocystis Pneumonia (PCP) in Solid Organ Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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