Abstract
BackgroundPneumocystis pneumonia (PCP) is a life-threatening fungal infection that can occur in kidney transplantation (KT) recipients. A growing number of KT recipients are receiving perioperative treatment with rituximab, which is associated with prolonged B-cell depletion and possible risk of PCP occurrence; however, the optimal prophylaxis duration according to rituximab treatment is yet unknown. We compared the occurrence of PCP and the duration of prophylaxis in KT recipients according to rituximab treatment.MethodsWe retrospectively analyzed 2110 patients who underwent KT between January 2009 and December 2016, who were divided into non-Rituximab group (n = 1588, 75.3%) and rituximab group (n = 522, 24.7%).ResultsIn the rituximab group, the estimated number needed to treat (NNT) for prophylaxis prolongation from 6 to 12 months was 29.0 with a relative risk reduction of 90.0%. In the non-rituximab group, the estimated NNT value was 133.3 and the relative risk reduction was 66.4%. Rituximab treatment (hazard ratio (HR) = 3.09; P < 0.01) and acute rejection (HR = 2.19; P = 0.03) were significant risk factors for PCP in multivariate analysis.ConclusionsOur results suggest that maintaining PCP prophylaxis for 12 months may be beneficial in KT recipients treated with rituximab for desensitization or acute rejection treatment.
Highlights
Pneumocystis pneumonia (PCP) is a life-threatening fungal infection that can occur in kidney transplantation (KT) recipients
Studies have shown that factors such as age, cytomegalovirus (CMV) infection, lymphopenia, immunosuppressive regimen, and acute graft rejection may serve as indications for extended prophylaxis; the exact duration of prophylaxis needed in each patient is not established, especially in KT recipients who had been treated with rituximab, a monoclonal antibody against CD20, for pre-transplant
Rituximab treatment was administered for desensitization owing to XM positivity in 126 (24.1%) patients, ABO incompatibility in 331 (63.4%) patients, both XM positivity and ABO incompatibility in 51 (9.8%) patients, and treatment of rejection that occurred within 6 months after KT in 14 (2.7%) patients
Summary
Pneumocystis pneumonia (PCP) is a life-threatening fungal infection that can occur in kidney transplantation (KT) recipients. We compared the occurrence of PCP and the duration of prophylaxis in KT recipients according to rituximab treatment. Pneumocystis pneumonia (PCP), which is caused by Pneumocystis jiroveci (P. jiroveci), is a life-threatening fungal infection that can occur in renal transplant recipients [1]. After encountering rituximab-treated KT recipients who later developed PCP at few months after prophylaxis discontinuation, we sought to obtain empirical evidence for the benefit of prolonged prophylaxis duration. We assessed the optimal duration of prophylaxis for PCP following KT in recipients who were treated with rituximab for pretransplant desensitization or rejection treatment within 6 months after transplant
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
