We report 50 confirmed PJP cases that occurred in kidney transplant patients between 06/16/2011 and 10/17/2015 in a single center.

In the studied period, there were 8.243 kidney transplant recipients in follow-up. Of the 50 cases of PJP, the mean age was 44.4 ± 11.5 years, 19 were male and 25 were Caucasians. The median time from transplantation to development of disease was 24 months (range, 1-175), and 47/50 (94%) recipients had PJP after six months of transplantation, when cotrimoxazole was routinely withdrawn. Initial manifestations included fever (33/50; 66%), cough (46/50; 92%) and dyspnea (45/50; 90%). Forty two (84%) patients presented with respiratory failure, and 34/50 (68%) required invasive ventilation. “Typical” ground glass opacities were found in 45/50 (90%) cases, but 20 (40%) patients had consolidations at CT scan. In 39 patients serum concentrations of lactic acid dehydrogenase (LDH) were increased (median 397U/L, range 128-1054). All but one patients had infection confirmed by histological analysis (this one had confirmation by bronchoalveolar lavage). Thirty-five patients developed acute renal injury and in 10 of them hemodialysis was required. Nineteen patients died (38%), and graft loss was observed in 6 cases (12%). After these cases, the major corrective measure was the reintroduction of cotrimoxazole prophylaxis to all patients indefinitely.

PJP is a potentially fatal disease with heterogeneous clinical and radiological presentation. It is necessary a high level of suspicion and prompt invasive diagnostic procedures.

CITATION INFORMATION: Viana L, Sandes T, Cristelli M, Oliveira A, Santos D, Tedesco-Silva H, Medina-Pestana J. Pneumocystis jirovecii Pneumonia: Late and Serious Complication Among Kidney Transplant Recipients. Am J Transplant. 2016;16 (suppl 3).

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