Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Feb;23(1):e13461.
doi: 10.1111/tid.13461. Epub 2020 Sep 23.

Alternative pneumocystis prophylaxis in solid organ transplant recipients at two large transplant centers

Jessica Lum  1 , Ignacio Echenique  2   3 , Vasilios Athans  4 , Christine E Koval  1
Affiliations

Alternative pneumocystis prophylaxis in solid organ transplant recipients at two large transplant centers

Jessica Lum et al. Transpl Infect Dis. 2021 Feb.

Abstract

Background: Trimethoprim-sulfamethoxazole (TMP-SMX) is the drug of choice for Pneumocystis jirovecii pneumonia (PJP) prophylaxis and has activity against other opportunistic infections (OIs) after solid organ transplant (SOT). We aimed to describe the incidence, reasons for and outcomes of use of alternative prophylactic agents (APAs) across SOT programs in our high volume centers.

Methods: Solid organ transplant recipients (SOTRs) at our centers from 1/2015-12/2016 were identified. Pharmacy records identified APA (pentamidine, atovaquone, or dapsone) use within 1 year. Records were reviewed for allergies, laboratory values at APA initiation, diagnostic tests for TMP-SMX-preventable OIs, and APA side effects.

Results: An APA was initiated in 105/1173 (8.9%) SOTRs. Of these, 51 (48.6%) were because of sulfonamide allergy recorded pre-SOT, mostly rash/hives (58.8%). The remaining 54 (51.4%) had TMP-SMX discontinued post-SOT, mostly for neutropenia (48%) and renal effects (34%). Differences occurred across programs, with kidney transplant never stopping TMP-SMX for renal issues. Of those changed to APAs post-transplant, 19 (35%) were later successfully re-challenged with TMP-SMX. With thresholds in mind, 67 (64%) received an APA unnecessarily, accounting for up to $100 000/y excess cost. Potential TMP-SMX-preventable OIs occurred in 7 (5 Nocardia; 2 PJP). APA side effects occurred in 14/105 (13.3%).

Conclusions: Use of APAs for PJP prophylaxis after SOT is less than previously reported but often unwarranted. Such decisions require scrutiny to avoid TMP-SMX-preventable OIs, cost and important APA side effects. Use of reasonable thresholds for cessation of TMP-SMX and data-driven approaches to re-challenge would substantially reduce APA use.

Keywords: pneumocystis; prophylaxis; transplant; trimethoprim/sulfamethoxazole.

PubMed Disclaimer

References

REFERENCES

    1. Iriart X, Challan Belval T, Fillaux J, et al. Risk factors of pneumocystis pneumonia in solid organ recipients in the era of the common use of post-transplantation prophylaxis. Am J Transplant. 2015;15(1):190-199.
    1. Neofytos D, Hirzel C, Boely E, et al. Pneumocystis jirovecii pneumonia in solid organ transplant recipients: a descriptive analysis for the Swiss Transplant Cohort. Transpl Infect Dis. 2018;20(6):1-12.
    1. Perez-Ordoño L, Hoyo I, Sanclemente G, et al. Late-onset Pneumocystis jirovecii pneumonia in solid organ transplant recipients. Trans Infect Dis. 2014;16(2):324-328.
    1. Fishman JA, Gans H Pneumocystis jiroveci in solid organ transplantation-guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;11:e13587.
    1. Schwartz BS, Mawhorter SD. Parasitic infections in solid organ transplantation. Am J Transplant. 2013;13(s4):280-303.

LinkOut - more resources