Seyed M Hosseini-Moghaddam1,2,3, Mostafa Shokoohi2, Gagandeep Singh3, Atul D Nagpal3, Anthony M Jevnikar3. 1. University Health Network, Transplant Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, ON, Canada. 2. Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Canada. 3. Multiorgan Transplant Program, London Health Sciences Centre, Western University, London, Canada.
Abstract
BACKGROUND: Solid organ transplant (SOT) recipients are at risk of Pneumocystis pneumonia (PCP). PCP is associated with significant morbidity and mortality. The effect of acute T cell-mediated rejection (TCMR) on post-transplant PCP has not been determined yet. METHODS: In this case-control study, we estimated the risk of PCP following acute TCMR during a lookback period of 180 days. We also determined the effects of contributing factors such as CMV infection. RESULTS: We compared 15 SOT (8 kidney, 4 heart, 2 liver and 1 kidney-pancreas) recipients with PCP with 60 matched recipients who did not develop PCP (control group) during the study period (December 2013 to February 2016). PCP occurred after a complete course of prophylaxis (i.e., late-onset PCP) in 60% of patients. Patients with PCP frequently required intensive care unit (ICU) admission (73.3%). Post-transplant PCP was associated with considerable allograft loss (53.4%) and mortality (26.7%). In the 6-month lookback period, acute TCMR (OR: 13.1, 95% CI: 3.2, 53.2) and CMV infection (OR:15.1,95% CI:4.0, 53.2.1) were significantly associated with post-transplant PCP. CONCLUSIONS: Post-transplant PCP is associated with substantial risk of ICU admission, allograft failure and mortality. Anti-Pneumocystis prophylaxis for at least 6 months following acute TCMR may reduce the risk. This article is protected by copyright. All rights reserved.
BACKGROUND: Solid organ transplant (SOT) recipients are at risk of Pneumocystis pneumonia (PCP). PCP is associated with significant morbidity and mortality. The effect of acute T cell-mediated rejection (TCMR) on post-transplant PCP has not been determined yet. METHODS: In this case-control study, we estimated the risk of PCP following acute TCMR during a lookback period of 180 days. We also determined the effects of contributing factors such as CMV infection. RESULTS: We compared 15 SOT (8 kidney, 4 heart, 2 liver and 1 kidney-pancreas) recipients with PCP with 60 matched recipients who did not develop PCP (control group) during the study period (December 2013 to February 2016). PCP occurred after a complete course of prophylaxis (i.e., late-onset PCP) in 60% of patients. Patients with PCP frequently required intensive care unit (ICU) admission (73.3%). Post-transplant PCP was associated with considerable allograft loss (53.4%) and mortality (26.7%). In the 6-month lookback period, acute TCMR (OR: 13.1, 95% CI: 3.2, 53.2) and CMV infection (OR:15.1,95% CI:4.0, 53.2.1) were significantly associated with post-transplant PCP. CONCLUSIONS: Post-transplant PCP is associated with substantial risk of ICU admission, allograft failure and mortality. Anti-Pneumocystis prophylaxis for at least 6 months following acute TCMR may reduce the risk. This article is protected by copyright. All rights reserved.
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Keywords:
zzm321990Pneumocystis jiroveciizzm321990; pneumocystis pneumonia; solid organ transplantation
Authors: Philip B Andreasen; Omid Rezahosseini; Dina L Møller; Neval E Wareham; Magda T Thomsen; Ranya Houmami; Andreas D Knudsen; Jenny Knudsen; Jørgen A L Kurtzhals; Andreas A Rostved; Christian R Pedersen; Allan Rasmussen; Susanne D Nielsen Journal: Immun Inflamm Dis Date: 2021-10-29