Elsevier

Transplantation Proceedings

Volume 41, Issue 1, January–February 2009, Pages 170-172
Transplantation Proceedings

Complication
Infection
Cluster Outbreak of Pneumocystis Pneumonia Among Kidney Transplant Patients Within a Single Center

https://doi.org/10.1016/j.transproceed.2008.10.027Get rights and content

Abstract

Pneumocystis pneumonia (PCP), a life-threatening opportunistic infection occurring in immunocompromised hosts, developed in 10 patients in the past 35 years at our hospital. Among the 7 outpatients and 3 inpatients, 9 cases clustered within 7 months. The mean time was 32.1 ± 27.5 months between transplantation and PCP diagnosis. The mortality rate was 33.3%. The patients developing PCP were older at transplantation (46.9 ± 11.8 vs 34.0 ± 11.1 years; P = .003) and had a longer pretransplantation dialysis period (146.3 ± 120.0 vs 51.3 ± 66.6 months; P < .0001). Multivariate analysis showed that age at transplantation and the use of mycophenolate mofetil (MMF) were risk factors for development of PCP. Despite prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) during the first 3 to 6 months after transplantation, the time period that showed the highest incidence rate of PCP, the disease may occur at later intervals.

Section snippets

Patients and Methods

Among 441 patients who underwent kidney transplantation between February 1973 and January 2008, PCP occurred in 10 recipients in 35 years. No patient had received TMP-SMX prior to overt evidence of a PCP infection. Several immunosuppressive protocols were used in this period: azathioprine and steroids from 1973–1984; cyclosporine in 1984; and tacrolimus since 1990. Mycophenolate mofetil (MMF) and basiliximab have been used at our hospital since 1995 and 2002, respectively. The PCP diagnosis was

Results

Table 1 shows the demographic data of 441 patients who underwent kidney transplantation. Nine cases were affected as a cluster between June 2007 and January 2008 and the remaining one in 1988. Seven cases were affected in an outpatient setting and the remaining 3 during hospitalization. No overlap of hospital admission was found among the 3 inpatients. Likewise, no specific personal contact was identified among the outpatients prior to overt PCP infection. Overall mortality rate was 33.3%; all

Discussion

P. jirovecii is an opportunistic pathogen especially found in patients with impaired cellular immunity.4, 5, 6 The reported prevalence of PCP has reached 10% within the first 6 months after transplantation,7 suggesting that the risk for PCP development is greater during the early phase after transplantation, especially under intensive immunosuppression.14, 15 The mortality rate of PCP in this study was 33.3%, which was compatible with rates reported previously (29%–50%).2, 3 Radistic et al13

References (16)

There are more references available in the full text version of this article.

Cited by (0)

View full text