Background

Pneumocystis jirovecii pneumonia (PCP) usually occurs during the first year after solid organ transplantation. Introduction of routine prophylaxis have reduced the incidence of PCP drastically. However, late-onset PCP still remains a life-threatening infection for patient who received prophylaxis.

Methods

A total of 2292 adult patients who received single kidney transplantation between 1990 and 2010 were reviewed in this retrospective study. All the patients received 12 months of trimethoprim-sulfamethoxaozle (TMP-SMX) prophylaxis after transplantation. Late-onset PCP was defined as PCP occurs after three years post-transplant. In a retrospective case-control study, we attempted to match cases by age, sex, and the year of transplantation in a 3:1 ratio.

Results

A total of 21 patients developed late-onset PCP, and 8 of them succumbed (38.1%). The median time to development of late-onset PCP after transplantation was 150 months (range, 52 to 291 months). Nine patients received intensified immunosuppression or changed their immunosuppressive regimen within the last 3 months prior to PCP due to rejection, Kaposi sarcoma, lymphoma, and CNI toxicity. By univariate analysis, use of rituximab, cancer chemotherapy, rejection, and lymphopenia (total lymphocytes count < 800/mm³) appeared to be PCP risk factors. In the multivariate analysis, lymphopenia was the only independently associated with late-onset PCP (OR, 8.92; 95% CI, 3.24 to 24.55; p<0.001).

Conclusion

Even after primary TMP-SMX prophylaxis, PCP could occur a long time after transplantation. Lymphopenia was an independent risk factor for late onset PCP. Clinical suspicions for PCP in patients with lymphopenia are required to avoid a therapeutic delay.

CITATION INFORMATION: Lee J, Lee J, Song S, Lee J, Kwon S.-K, Kim B, Kim M, Kim S, Kim Y, Huh K. Late-Onset Pneumocystis Jirovecii Pneumonia After Renal Transplantation: A Case-Control Study. Am J Transplant. 2016;16 (suppl 3).

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