Impact of Pneumocystis jirovecii pneumonia on kidney transplant outcome

Ji Eun Kim,Yon Su Kim,Seung Seok Han,Jongwon Ha,Ahram Han,Hajeong Lee

doi:10.1186/s12882-019-1407-x

Abstract

BackgroundsPneumocystis jirovecii pneumonia (PCP) remains an important cause of morbidity and mortality in kidney transplant recipients. While the acute phase toxicity in patients with PCP is well-characterized, there is a lack of data on the effects of PCP on long-term graft outcome.MethodThis retrospective observational study analyzed 1502 adult patients who underwent kidney transplantation at Seoul National University Hospital between 2000 and 2017. After a propensity score matching was performed, the graft and survival outcomes were compared between PCP-negative and PCP-positive groups.ResultsA total of 68 patients (4.5%) developed PCP after transplantation. The multivariable Cox analysis showed that positivity for cytomegalovirus and lack of initial oral antibiotic prophylaxis were risk factors of post-transplant PCP. The PCP-positive group had higher hazard ratios of graft failure [adjusted hazard ratio (HR), 3.1 (1.14–8.26); P = 0.027] and mortality [adjusted HR, 11.0 (3.68–32.80); P < 0.001] than the PCP-negative group. However, the PCP event was not related with subsequent development of de novo donor-specific antibodies or pathologic findings, such as T-cell or antibody mediated rejection and interstitial fibrosis and tubular atrophy.ConclusionsPCP is a risk factor of long-term graft failure and mortality, irrespective of rejection. Accordingly, appropriate prophylaxis and treatment is needed to avoid adverse transplant outcomes of PCP.

Highlights

With the continued development of immunosuppressive regimens in the past decade, death-censored graft failures have gradually decreased in recipients of both living and deceased kidney recipients [1, 2]
The P. jirovecii pneumonia (PCP) event was not related with subsequent development of de novo donor-specific antibodies or pathologic findings, such as T-cell or antibody mediated rejection and interstitial fibrosis and tubular atrophy
PCP was defined as the presence of findings suspicious of PCP detected by a radiologist on chest computed tomography combined with PCP positivity on polymerase chain reaction or direct immunofluorescence stain of sputum or bronchoalveolar lavage fluid

Summary

Introduction

With the continued development of immunosuppressive regimens in the past decade, death-censored graft failures have gradually decreased in recipients of both living and deceased kidney recipients [1, 2]. Infection is an important factor in relation to the risk of death in kidney transplant recipients, and the second most common cause of death after cardiovascular disease in patients with functioning grafts [3,4,5]. Several studies have investigated the relationship between PCP and mortality [9, 10], but the effect of PCP on graft rejection and overall graft outcomes has been less-well explored Certain infections such as cytomegalovirus (CMV) and BK virus have demonstrated relationships with acute rejection during the early posttransplant period [11,12,13,14]. This is a meaningful clinical issue, given that appropriate infection prophylaxis and treatment regimens could be implemented to

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Conclusion