Abstract: SA-PO1014
Late Pneumocystis jiroveci Pneumonias in Kidney Transplant Recipients in Central Norway
Session Information
- Transplantation: Clinical - 4
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Øvrehus, Marius Altern, Norges Teknisk-Naturvitenskapelige Universitet, Trondheim, Norway
- Lund, Jakob, Norges Teknisk-Naturvitenskapelige Universitet, Trondheim, Norway
- Kehreman, Robin Kirmizi, Norges Teknisk-Naturvitenskapelige Universitet, Trondheim, Norway
Background
Pneumocystis jirovecii pneumonia (PCP) can be life threatening in kidney transplant recipients (KTR). We know little about the course of late onset PCP - occurring later than one year after transplantation - in KTR.
Methods
Retrospective study using electronic patient charts in KTR diagnosed with PCP between 2006 and 2021 in Central Norway, which has a population of 697,000. We collected clinical data (table).
Results
We found 38 kidney transplant recipients with PCP. Median age 60 years, most on standard immunosuppression. Median length of hospitalization was 2 weeks, 32% received organ support treatment. Total mortality 18,4% within 180 days. The incidence was 0,4 cases/100,000 inhabitants.
Conclusion
We found that PCP had a serious course with organ failure, need of organ support, and 180 day mortality of 18%. In spite of the recommendation of life-long prophylaxis after PCP, 30% were not started on TMS at discharge.
| PCP patients (n) | 38 |
| Age, median, (q1-q3) | 60 (56-66) |
| Male, n (%) | 25 (65,8) |
| Last eGFR (stable phase), mL/min (n = 31), median, (q1-q3) | 36 (27-54) |
| In dialysis, n (%) | 7 (18,4) |
| Years since kidney tx, median, (q1-q3) | 8 (4,8-18) |
| Years on immunosuppression, median, (q1-q3) | |
| Corticosteroids (n = 38) | 8 (4-14) |
| CNI (n = 36) | 8 (3,8-14) |
| MMF/MMS (n = 35) | 6 (3,5-11) |
| Azathioprin (n = 7) | 18 (7,5-20) |
| Everolimus/sirolimus (n = 6) | 2,5 (1,3-3,8) |
| Days from symptom onset to diagnosis, median, (q1-q3) | 11,5 (7-22) |
| CRP median, (q1-q3) (n = 38, mg/L) at diagnosis, | 84 (52-112) |
| Leukocytes, median, (q1-q3) (n = 38, x 109/L) at diagnosis | 7,8 (5,4-9,8) |
| Chest X ray pathology, any (n = 36) at diagnosis | 97% |
| CT thorax pathology, any (n = 36) at diagnosis | 100% |
| Microbiological diagnosis: bronchoscopy with BAL n (%) | 34 (89,5) |
| Microbiological diagnosis: other n (%) | 7 (18,4) |
| Antibiotic treatment: trimethoprim-sulfametoxazol, n (%) | 34 (89,5) |
| Antibiotic treatment: clindamycin + primaquine, n (%) | 10 (26,3) |
| Days in hospital, median, (q1-q3) (n = 38) | 17 (11-27) |
| Days in ICU, median, (q1-q3) (n = 10) | 22 (17-24) |
| Days on respirator, median, (q1-q3) (n = 8) | 15 (12-23) |
| Days wih new onset dialysis, median, (q1-q3) (n = 5) | 15 (12-15) |
| Mortality, in hospital, n (%) (n = 38) | 6 (15,8) |
| Mortality, within 180 d after discharge, n (%) (n = 32) | 1 (3,1) |
| Mortality, total, n (%) (n = 38) | 7 (18,4) |
| Prophylaxis against P. jirovecii at discharge (n = 32), n (%) | 23 (71,9) |
Funding
- Government Support – Non-U.S.