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Published on: July 19, 2019
Pentamidine in Pneumocystis jirovecii prophylaxis in heart transplant recipients
Adem Ilkay Diken1, Ozlem Erçen Diken1, Onur Hanedan1
1Adem Ilkay Diken, Seyhan Yılmaz, Emir Erol, Adnan Yalçınkaya, Department of Cardiovascular Surgery, Hitit University Faculty of Medicine, 19100 Corum, Turkey.
Abstract:
Despite advances in transplantation techniques and the quality of post-transplantation care, opportunistic infections remain an important cause of complications. Pneumocystis jirovecii (P. jirovecii) is an opportunistic organism, represents an important cause of infections in heart transplantation patients. Almost 2% to 10% of patients undergoing cardiac transplantation have Pneumocystis pneumonia. Prophylaxis is essential after surgery. Various prophylaxis regimes had been defined in past and have different advantages. Trimethoprim/sulfamethoxazole (TMP/SMX) has a key role in prophylaxis against P. jirovecii. Generally, although TMP/SMX is well tolerated, serious side effects have also been reported during its use. Pentamidine is an alternative prophylaxis agent when TMP/SMX cannot be tolerated by the patient. Structurally, pentamidine is an aromatic diamidine compound with antiprotozoal activity. Since it is not effectively absorbed from the gastrointestinal tract, it is frequently administered via the intravenous route. Pentamidine can alternatively be administered through inhalation at a monthly dose in heart transplant recipients. Although, the efficiency and safety of this drug is well studied in other types of solid organ transplantations, there are only few data about pentamidine usage in heart transplantation. We sought to evaluate evidence-based assessment of the use of pentamidine against P. jirovecii after heart transplantation.
Insights
Pneumocystis pneumonia is a risk for heart transplant patients. Pentamidine offers an alternative prophylaxis when trimethoprim/sulfamethoxazole is not tolerated, though its use in heart transplants requires further evaluation.
Area of Science:
- Immunology
- Infectious Diseases
- Transplantation Medicine
Background:
- Opportunistic infections, particularly Pneumocystis jirovecii pneumonia (PCP), are significant complications post-heart transplantation.
- Prophylaxis is crucial to prevent PCP in cardiac transplant recipients, with trimethoprim/sulfamethoxazole (TMP/SMX) being a primary choice.
- TMP/SMX can cause serious side effects, necessitating alternative prophylactic agents.
Purpose of the Study:
- To conduct an evidence-based assessment of pentamidine's use for Pneumocystis jirovecii prophylaxis in heart transplant recipients.
- To evaluate the safety and efficacy of pentamidine as an alternative to TMP/SMX in this patient population.
- To address the limited data on pentamidine's application in heart transplantation compared to other solid organ transplants.
Main Methods:
- Systematic review of existing literature on pentamidine prophylaxis for P. jirovecii in heart transplant patients.
- Analysis of studies comparing pentamidine to TMP/SMX or placebo.
- Evaluation of safety profiles and adverse events associated with pentamidine administration.
Main Results:
- Data on pentamidine use in heart transplant recipients for P. jirovecii prophylaxis is limited.
- Pentamidine is an alternative for patients intolerant to TMP/SMX, often administered via inhalation.
- Further research is needed to establish optimal dosing and long-term safety in this specific group.
Conclusions:
- Pentamidine represents a viable alternative for Pneumocystis jirovecii prophylaxis in heart transplant patients unable to tolerate TMP/SMX.
- More clinical data is required to fully understand the efficacy and safety of pentamidine in the context of heart transplantation.
- Evidence-based guidelines for pentamidine use in heart transplant recipients are needed to optimize patient care and prevent opportunistic infections.
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