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Pneumocystis carinii pneumonia in infants after heart transplantation

D Janner1, J Bork, M Baum

  • 1Department of Pediatrics, Loma Linda Medical Center, CA 92354, USA.

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
|August 1, 1996
PubMed

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.

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