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
. 2022 Jun 23;12(1):10682.
doi: 10.1038/s41598-022-14580-5.

Comparison of early and late Pneumocystis jirovecii Pneumonia in kidney transplant patients: the Korean Organ Transplantation Registry (KOTRY) Study

Gongmyung Lee  1 , Tai Yeon Koo  2 , Hyung Woo Kim  1 , Dong Ryeol Lee  3 , Dong Won Lee  4 , Jieun Oh  5 , Beom Seok Kim  1 , Myoung Soo Kim  6 , Jaeseok Yang  7 ; KOTRY Study Group
Collaborators, Affiliations

Comparison of early and late Pneumocystis jirovecii Pneumonia in kidney transplant patients: the Korean Organ Transplantation Registry (KOTRY) Study

Gongmyung Lee et al. Sci Rep. .

Abstract

Late Pneumocystis jirovecii pneumonia (PJP) is not rare in the era of universal prophylaxis after kidney transplantation. We aimed to determine the nationwide status of PJP prophylaxis in Korea and compare the incidence, risk factors, and outcomes of early and late PJP using data from the Korean Organ Transplantation Registry (KOTRY), a nationwide Korean transplant cohort. We conducted a retrospective analysis using data of 4,839 kidney transplant patients from KOTRY between 2014 and 2018, excluding patients who received multi-organ transplantation or were under 18 years old. Cox regression analysis was performed to determine risk factors for early and late PJP. A total of 50 patients developed PJP. The number of patients who developed PJP was same between onset before 6 months and onsets after 6 months. There were no differences in the rate, duration, or dose of PJP prophylaxis between early and late PJP. Desensitization, higher tacrolimus dose at discharge, and acute rejection were associated with early PJP. In late PJP, old age as well as acute rejection were significant risk factors. In conclusion late PJP is as common and risky as early PJP and requires individualized risk-based prophylaxis, such as prolonged prophylaxis for old patients with a history of rejection.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Prophylaxis regimens for Pneumocystis jirovecii pneumonia in Korea. (a) PJP prophylaxis policy of 32 transplantation centers. Indicated prophylaxis was applied to patients that had received desensitization, ATG or rituximab, or received anti-rejection therapy. (b) Duration of PJP prophylaxis. (c) Dose of for PJP prophylaxis. ATG, anti-thymocyte globulin; PJP, Pneumocystis jirovecii pneumonia; SMP, sulfamexothazole; TMP, trimethoprim.
Figure 2
Figure 2
Development of Pneumocystis jirovecii pneumonia and its impact on mortality. (a) PJP-free survival rate after kidney transplantation. (b) Comparison of mortality between PJP and non-PJP groups (log rank test, P < 0.001). (c) Comparison of mortality between early and late PJP groups (log rank test, P = 0.546). PJP, Pneumocystis jirovecii pneumonia.
See this image and copyright information in PMC

References

    1. Sassi M, et al. Outbreaks of Pneumocystis pneumonia in 2 renal transplant centers linked to a single strain of Pneumocystis: implications for transmission and virulence. Clin. Infect. Dis. 2012;54:1437–1444. doi: 10.1093/cid/cis217. - DOI - PMC - PubMed
    1. Munksgaard B. Pneumocystis jiroveci (formerly Pneumocystis carinii) Am. J. Transplant. 2004;4:135–141. doi: 10.1111/j.1600-6135.2004.00736.x. - DOI - PubMed
    1. Fishman JA. Prevention of infection due to Pneumocystis carinii. Antimicrobial. Agents Chemother. 1998;42:995–1004. doi: 10.1128/AAC.42.5.995. - DOI - PMC - PubMed
    1. Iriart X, Bouar ML, Kamar N, Berry A. Pneumocystis pneumonia in solid-organ transplant recipients. J. Fungi. (Basel) 2015;1:293–331. doi: 10.3390/jof1030293. - DOI - PMC - PubMed
    1. Hill, P., Cross, N. B., Barnett, A. N. R., Palmer, S. C. & Webster, A. C. Polyclonal and monoclonal antibodies for induction therapy in kidney transplant recipients. Cochrane Database Syst. Rev.1, Ccd004759 (2017). - PMC - PubMed

Publication types