Pneumocystis jiroveci Pneumonia Infections in Pediatric Solid Organ Transplant Recipients

PJP is a rare but potentially life-threatening infection seen in immunocompromised patients. We sought to determine the risk factors for acquiring Pneumocystis jirovecii pneumonia (PJP) in pediatric solid organ transplant (SOT) recipients and the associated morbidity, mortality, and hospital resource use.

Patients ≤ 18 years who underwent solid organ transplantation from 1/1/2003-12/31/2022 at hospitals utilizing the Pediatric Health Information System database were identified. Their transplant hospitalization and subsequent hospitalizations were analyzed. Risk factors for PJP infections were evaluated using Cox survival analysis adjusted for confounders.

Among the total 18 104 SOT recipients, 59 (0.3%) were admitted with PJP during the study period, of which 17% were considered breakthrough infections. The majority of PJP infections occurred early post-transplant, with a median time to infection of 1.2 years (interquartile range [IQR] 0.4-1.9 years) post-transplant. In adjusted analyses, there was an increased risk of PJP in patients who underwent heart transplantation and patients who were < 1 year of age at the time of transplant. The median length of stay for a PJP hospitalization was 16 days (IQR 7-31 days) with a median adjusted total cost of $57 142 (IQR $25 009-$154 251). The overall mortality rate was 9%.

In the current era, PJP remains a rare post-transplant complication in pediatric SOT patients. PJP infections occurred more frequently among infants and heart transplant recipients, and were associated with significant morbidity, mortality, and costs. Further studies are needed to identify patient-specific risk factors for PJP among pediatric SOT recipients and define indications for extended PJP prophylaxis or reinitiation.