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Dapsone-induced methemoglobinemia in pediatrics post-renal transplant

Aditi Hindka1,2, Dao Huynh1, Priya S Verghese3,4

  • 1Division of Nephrology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.

Pediatric Transplantation
|December 6, 2020
PubMed

Insights

Pediatric kidney transplant patients on dapsone for Pneumocystis pneumonia (PJP) prophylaxis frequently develop methemoglobinemia and anemia. Routine screening for these conditions is recommended to monitor dapsone

Area of Science:

  • Nephrology
  • Pharmacology
  • Infectious Disease

Background:

  • Dapsone is used for Pneumocystis jirovecii pneumonia (PJP) prophylaxis in pediatric kidney transplant recipients when trimethoprim-sulfamethoxazole (TMP-SMX) is contraindicated.
  • Adverse effects of dapsone, such as methemoglobinemia, are known but their incidence and impact in this specific population are not well-documented.
  • This study addresses the gap in understanding methemoglobinemia burden in pediatric kidney transplant recipients on dapsone.

Purpose of the Study:

  • To assess the incidence and impact of methemoglobinemia and anemia in pediatric kidney transplant recipients receiving dapsone for PJP prophylaxis.
  • To evaluate the screening practices for methemoglobinemia in this patient cohort.

Main Methods:

  • A retrospective chart review was conducted on pediatric kidney transplant recipients treated with dapsone post-transplant.
  • Data collected included dapsone indication, duration, adverse effects, and methemoglobin levels.
  • Summary statistics were performed to analyze the findings.

Main Results:

  • Over half of the patients on dapsone were not screened for methemoglobinemia.
  • Acquired methemoglobinemia was observed in 77% of screened patients, a significantly higher rate than previously reported.
  • Patients on dapsone also showed a significantly higher incidence of anemia; however, neither condition affected patient or graft survival.

Conclusions:

  • Pediatric kidney transplant recipients frequently develop methemoglobinemia and/or anemia when treated with dapsone.
  • Methemoglobinemia and anemia resolved upon dapsone cessation.
  • Routine monitoring for methemoglobinemia and anemia is recommended for pediatric transplant recipients prescribed dapsone.

Keywords:
dapsonekidneymethemoglobinemianephrologypediatrictransplantation

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