- Though uncommon in the era of universal prophylaxis, late Pneumocystis jirovecii pneumonia (PJP) is tied to poor outcomes among kidney and kidney/pancreas transplant recipients.
- Cytomegalovirus (CMV) viremia is a strong prognostic factor.
Why this matters
- PJP prophylaxis should be extended or reinitated for ≥6 months for CMV viremia.
- Retrospective study of 6270 adults who had undergone kidney transplant with/without simultaneous pancreas transplant during 1994-2016; 28 (0.45%) developed PJP.
- Funding: None.
- Median time from transplant to PJP, 4.6 (interquartile range [IQR], 1.4-9.6) years.
- 10.7% of cases occurred in the first year (stopped prophylaxis early).
- PJP incidence was highest in second year (28.6%).
- In multivariate analysis, CMV viremia was the only significant prognostic factor for PJP (OR=6.27; P=.002).
- In 90% of cases, CMV viremia had been diagnosed in the year prior to PJP.
- Median time from CMV diagnosis to PJP, 3.4 (IQR, 1.74-11.5) months.
- Median peak CMV viral load prior to PJP, 3684.5 (IQR, 1034-93,300) IU/mL.
- 88.9% were on active treatment for CMV infection at PJP diagnosis.
- Compared with controls, PJP was tied to poorer 2-year patient survival (42.4% vs 88.5%) and graft survival (37.9% vs 79.9%; both P<.001>
- Monocentric design; small sample size.