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Published on: July 10, 2012
Pneumocystis carinii pneumonia in infants after heart transplantation
Insights
Pneumocystis pneumonia occurred in 7% of infant heart transplant recipients, primarily within 6 months post-operation. Risk factors include antithymocyte induction and transplant rejection episodes.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Transplantation Immunology
Background:
- The incidence of Pneumocystis carinii pneumonia (PCP) post-heart transplantation (HTx) is well-documented in adults but not in pediatric populations.
- Infants undergoing heart transplantation are a vulnerable group with limited data on PCP incidence.
Purpose of the Study:
- To determine the incidence of PCP in infants following heart transplantation.
- To identify risk factors and clinical features associated with PCP in this population.
Main Methods:
- Retrospective review of 152 infants (0-12 months) who underwent heart transplantation between November 1985 and December 1993.
- Analysis of patient data for PCP diagnosis, timing, clinical presentation, diagnostic methods, CD4 counts, and treatment outcomes.
- Comparison of PCP incidence based on antithymocyte induction and rejection episodes.
Main Results:
- PCP was diagnosed in 10 episodes (7%) among 152 infants, with a mean diagnosis time of 5 months post-transplant.
- Common clinical features included hypoxia, tachypnea, and interstitial infiltrates.
- Increased risk of PCP was associated with antithymocyte induction (p=0.05) and more than two rejection episodes in the first year (p=0.04).
- All cases were successfully treated with trimethoprim/sulfamethoxazole.
Conclusions:
- The incidence of PCP in infant heart transplant recipients is approximately 7%.
- PCP most frequently occurs within the first six months after transplantation.
- Early antithymocyte induction and increased rejection episodes are potential risk factors for PCP development in this cohort.
Abstract:
Although the reported incidence of Pneumocystis carinii pneumonia after heart transplantation in adults ranges from 3% to 40%, data are lacking regarding the incidence in the pediatric heart transplantation population. A retrospective review was performed on 152 infants (0 to 12 months of age) undergoing transplantation from November 1985 through December 1993 who survived at least 6 months after heart transplantation. Patients did not receive postoperative Pneumocystis carinii prophylaxis. Ten episodes (7%) were diagnosed in four neonates and six infants. The mean postoperative time to Pneumocystis carinii diagnosis was 5 months (range 3 to 9 months). Features of Pneumocystis carinii included hypoxia and tachypnea (10 of 10), progressive interstitial infiltrates (8 of 10), and persistent right middle lobe consolidation (1 of 10). Pneumocystis carinii was diagnosed with the use of bronchoscopy in eight cases and by open lung biopsy in two cases. Mean CD4 count available on five patients at the time of Pneumocystis carinii diagnosis was 413/mm3 (range 158 to 1358); 5 of 37 patients receiving antithymocyte induction had Pneumocystis carinii versus 5 of 115 patients who did not receive induction (p = 0.05). Patients were at increased risk for the development of Pneumocystis carinii if they had more than two episodes of rejection during the first year after heart transplantation (p = 0.04). All cases were successfully treated with trimethoprim/sulfamethoxazole. The incidence of Pneumocystis carinii in infant heart transplantation recipients is approximately 7% and appears most frequently in the first 6 months after the operation. Increased risk for Pneumocystis carinii may be related to early antithymocyte induction and increased episodes of rejection.
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