Risk factors for Pneumocystis jirovecii pneumonia (PJP) in kidney transplantation recipients

Su Hwan Lee,Yu Seun Kim,Joon Chang,Se Kyu Kim,Soon Il Kim,Moo Suk Park,Dong Jin Joo,Young Sam Kim,Kyu Ha Huh,Myoung Soo Kim,Song Yee Kim,Juhan Lee

doi:10.1038/s41598-017-01818-w

Abstract

Pneumocystis jirovecii pneumonia (PJP) is a potentially life-threatening infection that occurs in immunocompromised patients. The aim of this study was to evaluate risk factors for PJP in kidney transplantation recipients. We conducted a retrospective analysis of patient data from 500 consecutive kidney transplants performed at Severance Hospital between April 2011 and April 2014. Eighteen kidney transplantation recipients (3.6%) were diagnosed with PJP. In the univariate analysis, acute graft rejection, CMV infection, use of medication for diabetes mellitus, and lowest lymphocyte count were associated with PJP. Recipients who experienced acute graft rejection (odds ratio [OR] 11.81, 95% confidence interval [CI] 3.06–45.57, P < 0.001) or developed CMV infection (OR 5.42, 95% CI 1.69–17.39, P = 0.005) had high odds of PJP in multivariate analysis. In the acute graft rejection subgroup, patients treated with anti-thymocyte globulin (ATG) had significantly higher odds of PJP (OR 5.25, 95% CI 1.01–27.36, P = 0.006) than those who were not. Our data suggest that acute graft rejection and CMV infection may be risk factors for PJP in kidney transplant patients. The use of ATG for acute graft rejection may increase the risk of PJP.

Highlights

Pneumocystis jirovecii pneumonia (PJP) is a potentially life-threatening infection that occurs in immunocompromised patients
Pneumocystis jirovecii pneumonia (PJP) previously known as Pneumocystis carinii pneumonia is a potentially life-threatening infection that occurs in immunocompromised patients[1, 2]
To understand the impact of acute graft rejection and CMV pneumonia on PJP, we investigated the timing of the onset of PJP after acute graft rejection or CMV infection

Summary

Introduction

Pneumocystis jirovecii pneumonia (PJP) is a potentially life-threatening infection that occurs in immunocompromised patients. Our data suggest that acute graft rejection and CMV infection may be risk factors for PJP in kidney transplant patients. The incidence rate of PJP has decreased with the use of prophylaxis, an increasing number of PJP outbreaks in kidney transplant centers has been reported worldwide in recent years[4, 5, 11] The causes of those outbreaks have not fully been evaluated. The overall load of immunosuppressive therapy, higher donor age, higher recipient age, lymphopenia, previous cytomegalovirus (CMV) infection, or treatment used for episodes of graft rejection have been reported as risk factors for PJP in kidney transplant patients[12,13,14,15,16,17]. The aim of this study was to evaluate the risk factors for PJP in kidney transplantation recipients

Objectives

Methods

Results

Conclusion