Pneumocystis jirovecii pneumonia in solid organ transplant recipients: a prospective observational cohort study

Pneumocystis pneumonia (PCP) is a well-known infectious complication of organ transplantation requiring prophylaxis at least within the first 6 month to 1 year post transplantation.

Few data exist comparing the characteristics of Pneumocystis pneumonia associated with kidney, heart, liver or lung transplant recipients.

We here conducted a cross-sectional study nested within the surveillance of our national reference center for invasive mycoses to analyze the prospectively declared cases of PCP occurring in solid organ transplant recipients over a period of 11 years.

We found that the median occurrence of PCP post-transplantation varies from the organ recipients with PCP occurring earlier in liver recipients and later in other organs reaching a median of 3.9 years in kidney recipients. We also found a clear increase the proportion of positive mycological criteria in PCP cases occurring within 2 years post-transplantation. Age and ICU hospitalization were major variables associated with 3 month-mortality with liver and lung recipient having a better outcome than renal transplant patients upon adjustment including age. A trend toward the role of additional risk factors (such as HIV, Cancer of hematological malignancy) in the outcome of PCP was also observed.

Altogether, this study described on a large patient cohort, some key mycological and clinical information associated with PCP in solid organ transplant patients. The characteristics of PCP in kidney and heart recipients seems similar.