Kidney transplant: CMV viremia predicts subsequent PJP

  • Garg N & al.
  • BMC Nephrol
  • 21 Nov 2018

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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>

Limitations

  • Monocentric design; small sample size.

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