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Pneumocystis jirovecii pneumonia in liver transplant recipients: a systematic review

I D Kostakis1, G C Sotiropoulos1, G Kouraklis1

  • 1Second Department of Propedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece.

Transplantation Proceedings
|November 26, 2014
PubMed
Abstract

Insights

Prophylactic trimethoprim-sulfamethoxazole significantly reduces the incidence and mortality of Pneumocystis jirovecii pneumonia (PJP) in liver transplant recipients. Extended use for one year post-transplant is recommended to prevent this opportunistic infection.

Area of Science:

  • Infectious Diseases
  • Transplant Surgery
  • Mycology

Background:

  • Pneumocystis jirovecii causes pneumonia in immunocompromised individuals.
  • Liver transplant recipients are particularly susceptible to P. jirovecii infections.

Purpose of the Study:

  • To review the incidence and outcomes of P. jirovecii pneumonia (PJP) in liver transplant recipients.
  • To evaluate the effectiveness of prophylactic treatment for PJP in this patient population.

Main Methods:

  • A systematic literature search was conducted using Medline.
  • Keywords included "liver transplantation" and "pneumocystis."
  • 35 relevant articles were selected for review from 60 initial results.

Main Results:

  • PJP incidence in liver transplant recipients without prophylaxis ranges from 1% to 11%, with mortality rates between 7% and 88%.
  • Most PJP cases occur within 7 months post-transplantation.
  • Prophylaxis with oral trimethoprim-sulfamethoxazole reduces PJP incidence to 0%-3%.

Conclusions:

  • PJP poses a significant risk of high incidence and mortality in liver transplant recipients without prophylaxis.
  • Oral trimethoprim-sulfamethoxazole prophylaxis is highly effective in preventing PJP.
  • Prophylaxis should be administered for one year following liver transplantation.

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