Comparative Risk of Acute Anemia and Urinary Tract Infection With Sulfamethoxazole-Trimethoprim Versus Dapsone After...

Dapsone is an alternative prophylactic agent for opportunistic infection in kidney transplant recipients (KTRs) with sufficient glucose-6-phosphate dehydrogenase levels. Potential disadvantages include increased risk for anemia and urinary tract infection (UTI) with dapsone.

The objective of this study was to compare the risks of anemia and UTI in KTRs who received prophylaxis for opportunistic infection after renal transplant with dapsone versus sulfamethoxazole-trimethoprim (SMX-TMP).

This single-center, retrospective, cohort review was conducted at a large academic health system. Adult patients who received SMX-TMP or dapsone prophylaxis after renal transplant were included. The primary outcome was risk of acute anemia within 90 days of transplant. Secondary outcomes included the risk of UTI post-transplant. Log-rank test was used for time-to-event analysis for the primary outcome.

A total of 153 patients were included in the analysis. Patients were more likely to experience acute anemia while on dapsone compared with SMX-TMP (hazard ratio = 2.13, 95% confidence interval = 1.04-4.38, P = 0.04). No differences were observed in the rates of blood transfusion (14.5% vs 18.4%, P = 0.52) or use of erythropoiesis-stimulating agents (40.2% vs 48.7%, P = 0.331) between SMX-TMP and dapsone groups, respectively. The prevalence of UTI was comparable between groups (23.4% vs 23.7%, P > 0.999).

The risk of anemia was twofold higher in KTRs who received dapsone compared with SMX-TMP but did not appear to affect the rates of erythropoiesis-stimulating agent use or blood transfusion. There was no difference in the risk of UTI. These findings may inform agent selection and monitoring of prophylaxis for opportunistic infection in KTRs.