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Updated: Jan 28, 2026
Murine Renal Transplantation Procedure
Published on: July 10, 2009
Lessons learned from a pneumocystis pneumonia outbreak at a Scottish renal transplant centre
A McClarey1, P Phelan1, D O'Shea2
1Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
Insights
Renal transplant patients face a continued risk of Pneumocystis pneumonia (PCP) years post-transplant. Lower kidney function and cytomegalovirus (CMV) infection are key risk factors, suggesting potential person-to-person transmission of PCP.
Area of Science:
- Nephrology
- Infectious Diseases
- Transplantation Immunology
Background:
- Pneumocystis pneumonia (PCP) is a significant opportunistic infection in renal transplant recipients.
- An observed increase in PCP cases within a renal transplant cohort prompted this investigation.
Purpose of the Study:
- To identify risk factors associated with the development of PCP in renal transplant patients.
- To understand the epidemiology of a PCP outbreak in a specific transplant population.
Main Methods:
- Retrospective analysis of hospital records comparing PCP cases with matched controls.
- Data collection included patient demographics, laboratory results, and pre/post-infection hospital visit history.
Main Results:
- No patients received PCP prophylaxis; PCP developed a mean of 4.7 years post-transplant.
- PCP patients exhibited significantly lower estimated glomerular filtration rates (eGFR) and higher rates of active cytomegalovirus (CMV) infection.
- Increased likelihood of shared hospital visits among PCP cases suggests potential person-to-person transmission.
Conclusions:
- Pneumocystis pneumonia remains a risk years after renal transplantation.
- Identified risk factors, including impaired kidney function and CMV co-infection, can guide targeted prophylaxis strategies.
- Findings support the possibility of person-to-person transmission of Pneumocystis jirovecii among vulnerable transplant patients.
Background:
Pneumocystis pneumonia (PCP) is an opportunistic infection occurring in renal transplant patients. Over a 14-month period an increase in PCP cases was identified among our renal transplant cohort.
Aim:
The outbreak population was studied to identify potential risk factors for the development of PCP.
Methods:
A retrospective analysis of hospital records was carried out, with each case being matched with two case-linked controls. Information was collected on patient demographics, laboratory tests, and hospital visits pre and post development of infection.
Findings:
No patients were receiving PCP prophylaxis at the time of infection and mean time from transplantation to developing PCP was 4.7 years (range: 0.51-14.5). The PCP group had a significantly lower mean estimated glomerular filtration rate than the control group (29.3 mL/min/1.73 m2 vs 70 mL/min-1 (P = 0.0007)). Three patients were treated for active cytomegalovirus (CMV) infection prior to PCP diagnosis and two had active CMV at the time of diagnosis compared to none in the control group (P = 0.001). Those who developed PCP were more likely to have shared a hospital visit with another patient who went on to develop PCP; 37% of clinic visits vs 19% (P = 0.014).
Conclusion:
This study highlights the ongoing risk of opportunistic infection several years after transplantation and adds weight to potential person-to-person Pneumocystis jirovecii transmission. Risk factors have been identified which may highlight those most at risk, enabling targeted rather than blanket long-term PCP prophylaxis.
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