Pneumocystis jirovecii Pneumonia in Solid-Organ Transplant Recipients: A National Center Experience.
Exp Clin Transplant
; 2020 Nov 27.
Article
de En
| MEDLINE
| ID: mdl-33272151
ABSTRACT
OBJECTIVES:
Immunosuppressive therapies have impro-ved survival in solid-organ transplant recipients at the expense of increased prevalence of opportunistic infections. We investigated the prevalence, risk factors, and prognosis of Pneumocystis jirovecii pneumonia in solid-organ transplant recipients who were followed by our transplant unit. MATERIALS ANDMETHODS:
We conducted a retrospective observational study using medical record reviews to identify all adult solid-organ transplant recipients who underwent bronchoscopy and bronchoalveolar lavage between January 2011 and 2018. We collected clinical characteristics, including risk factors and prognosis. Pneumocystis jirovecii pneumonia symptoms com-patible with microscopy and/or positive nucleic acid amplification assays were defined as proven infection by P. jirovecii pneumonia.RESULTS:
We identified 312 adult solid-organ transplants (114 renal, 1 kidney and pancreas, 197 liver) in this period. Overall, 113 (36.2%) pulmonary disease consultations were performed in the posttransplant stage, and 46 (40.7%) patients underwent bronchoalveolar lavage with P. jirovecii screening. We identified 18 patients who tested positive for P. jirovecii infection according to nucleic acid amplification assay; 3 were not proven, and 7 had a transplant date before 2011. The prevalence was 8/312 (2.6%); of these 8 patients, 5 had the same genotype cluster. Median P. jirovecii pneumonia development time was longer in renal transplant recipients (P = .016). Only renal transplant recipients were offered Pneumocystis prophylaxis for 6 months. Concomitant viral infection including cytomegalovirus was the only significant factor for P. jirovecii pneumonia development (P = .028). Intensive care admission was 40% (n = 6), and disease-related mortality was 33% (n = 5).CONCLUSIONS:
The overall prevalence of P. jirovecii pneumonia in solid-organ transplant recipients was similar to other single-center reports. Prophylaxis prevented early posttransplant P. jirovecii pneumonia. However, P. jirovecii pneumonia may develop at any posttransplant stage, and viral infections other than cytomegalovirus should also be considered as a predictor.
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Type d'étude:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Langue:
En
Journal:
Exp Clin Transplant
Sujet du journal:
TRANSPLANTE
Année:
2020
Type de document:
Article
Pays d'affiliation:
Turquie