Abstract
Background: Pneumocystis jirovecii pneumonia (PJP) affected 5%-15% of solid organ transplant (SOT) recipients prior to universal prophylaxis, classically with trimethoprim-sulfamethoxazole (TMP-SMX). Guidelines generally recommend 6-12 months of prophylaxis post-SOT, yet optimal duration and robust PJP risk stratification have not been established. Methods: A retrospective, single-center, case-control study of PJP among SOT recipients from January 1998 to December 2013 was conducted. Cases had positive PJ direct fluorescent antibody assay of respiratory specimens. Controls were matched 4:1 by nearest date of SOT. Univariate testing and multivariate logistic regressions were performed. Results: Fifteen cases were identified among 5505 SOT recipients (0.27% rate) and analyzed vs 60 controls. PJP occurred on average 6.1 years (range 0.9-13.8) post-SOT; no case was receiving PJP prophylaxis at diagnosis. Most were treated with reduced immunosuppression and TMP-SMX plus steroids (80%). Six patients (40%) required critical care; 3 (20%) died. There were no significant demographic differences, though cases tended to be older at SOT (54 vs 48 years, P =.1). In univariate analysis, prior viral infection was more common among cases (67% vs 37%, P =.08). Lower absolute lymphocyte count (ALC) at diagnosis date was strongly associated with PJP (400 vs 1230 × 10 6 cells/μL, P <.001); odds of infection were high with ALC ≤ 500 × 10 6 cells (OR 18.7, P <.01). Conclusion: Pneumocystis jirovecii pneumonia is a rare, late complication of SOT with significant morbidity and mortality. Severe lymphopenia may be useful in identifying SOT recipients who warrant continued or reinstated PJP prophylaxis.
| Original language | English (US) |
|---|---|
| Article number | e12876 |
| Journal | Transplant Infectious Disease |
| Volume | 20 |
| Issue number | 3 |
| DOIs | |
| State | Published - Jun 1 2018 |
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Keywords
- Pneumocystis
- organ transplantation
- pneumonia
- prophylaxis
ASJC Scopus subject areas
- Transplantation
- Infectious Diseases
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Lymphopenia is associated with late onset Pneumocystis jirovecii pneumonia in solid organ transplantation. / Werbel, W. A.; Ison, Michael G; Angarone, Michael Peter; Yang, A.; Stosor, Valentina.
In: Transplant Infectious Disease, Vol. 20, No. 3, e12876, 01.06.2018.Research output: Contribution to journal › Article
TY - JOUR
T1 - Lymphopenia is associated with late onset Pneumocystis jirovecii pneumonia in solid organ transplantation
AU - Werbel, W. A.
AU - Ison, Michael G
AU - Angarone, Michael Peter
AU - Yang, A.
AU - Stosor, Valentina
PY - 2018/6/1
Y1 - 2018/6/1
N2 - Background: Pneumocystis jirovecii pneumonia (PJP) affected 5%-15% of solid organ transplant (SOT) recipients prior to universal prophylaxis, classically with trimethoprim-sulfamethoxazole (TMP-SMX). Guidelines generally recommend 6-12 months of prophylaxis post-SOT, yet optimal duration and robust PJP risk stratification have not been established. Methods: A retrospective, single-center, case-control study of PJP among SOT recipients from January 1998 to December 2013 was conducted. Cases had positive PJ direct fluorescent antibody assay of respiratory specimens. Controls were matched 4:1 by nearest date of SOT. Univariate testing and multivariate logistic regressions were performed. Results: Fifteen cases were identified among 5505 SOT recipients (0.27% rate) and analyzed vs 60 controls. PJP occurred on average 6.1 years (range 0.9-13.8) post-SOT; no case was receiving PJP prophylaxis at diagnosis. Most were treated with reduced immunosuppression and TMP-SMX plus steroids (80%). Six patients (40%) required critical care; 3 (20%) died. There were no significant demographic differences, though cases tended to be older at SOT (54 vs 48 years, P =.1). In univariate analysis, prior viral infection was more common among cases (67% vs 37%, P =.08). Lower absolute lymphocyte count (ALC) at diagnosis date was strongly associated with PJP (400 vs 1230 × 10 6 cells/μL, P <.001); odds of infection were high with ALC ≤ 500 × 10 6 cells (OR 18.7, P <.01). Conclusion: Pneumocystis jirovecii pneumonia is a rare, late complication of SOT with significant morbidity and mortality. Severe lymphopenia may be useful in identifying SOT recipients who warrant continued or reinstated PJP prophylaxis.
AB - Background: Pneumocystis jirovecii pneumonia (PJP) affected 5%-15% of solid organ transplant (SOT) recipients prior to universal prophylaxis, classically with trimethoprim-sulfamethoxazole (TMP-SMX). Guidelines generally recommend 6-12 months of prophylaxis post-SOT, yet optimal duration and robust PJP risk stratification have not been established. Methods: A retrospective, single-center, case-control study of PJP among SOT recipients from January 1998 to December 2013 was conducted. Cases had positive PJ direct fluorescent antibody assay of respiratory specimens. Controls were matched 4:1 by nearest date of SOT. Univariate testing and multivariate logistic regressions were performed. Results: Fifteen cases were identified among 5505 SOT recipients (0.27% rate) and analyzed vs 60 controls. PJP occurred on average 6.1 years (range 0.9-13.8) post-SOT; no case was receiving PJP prophylaxis at diagnosis. Most were treated with reduced immunosuppression and TMP-SMX plus steroids (80%). Six patients (40%) required critical care; 3 (20%) died. There were no significant demographic differences, though cases tended to be older at SOT (54 vs 48 years, P =.1). In univariate analysis, prior viral infection was more common among cases (67% vs 37%, P =.08). Lower absolute lymphocyte count (ALC) at diagnosis date was strongly associated with PJP (400 vs 1230 × 10 6 cells/μL, P <.001); odds of infection were high with ALC ≤ 500 × 10 6 cells (OR 18.7, P <.01). Conclusion: Pneumocystis jirovecii pneumonia is a rare, late complication of SOT with significant morbidity and mortality. Severe lymphopenia may be useful in identifying SOT recipients who warrant continued or reinstated PJP prophylaxis.
KW - Pneumocystis
KW - organ transplantation
KW - pneumonia
KW - prophylaxis
UR - http://www.scopus.com/inward/record.url?scp=85044607407&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85044607407&partnerID=8YFLogxK
U2 - 10.1111/tid.12876
DO - 10.1111/tid.12876
M3 - Article
C2 - 29512868
AN - SCOPUS:85044607407
VL - 20
JO - Transplant Infectious Disease
JF - Transplant Infectious Disease
SN - 1398-2273
IS - 3
M1 - e12876
ER -