Six‐month risk of Pneumocystis pneumonia following acute cellular rejection: A case‐control study in solid organ transplant recipients

• Published in: Clinical transplantation 2021-07, Vol.35 (7), p.e14322-n/a
• Main Authors: Hosseini‐Moghaddam, Seyed M., Shokoohi, Mostafa, Singh, Gagandeep, Nagpal, Atul D., Jevnikar, Anthony M.
• Format: Article
• Language: English
• Subjects: Pneumocystis jirovecii; pneumocystis pneumonia; solid organ transplantation
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.14322

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 (ie, 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.