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Int. J. Infect. Dis., 2023 Jun;131:166-172 | https://doi.org/10.1016/j.ijid.2023.04.387 Risk factors for late-onset Pneumocystis jirovecii pneumonia in liver transplant recipients

Eun-Ki Min ^1,2, Juhan Lee ^1,2, Su Jin Jeong³, Deok-Gie Kim ^1,2, Seung Hyuk Yim ^1,2, Mun Chae Choi ^1,2, Dong Jin Joo ^1,2, Myoung Soo Kim ^1,2, Jae Geun Lee^1,2

¹Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
²The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea
³Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea

Corresponding author: Jae Geun Lee

Abstract

Objectives: The risk factors for late-onset Pneumocystis jirovecii pneumonia (PCP) after liver transplantation (LT) have not been well studied. We aimed to analyze the clinical features preceding PCP in LT recipients that would guide individualized prophylaxis.

Methods: Among 742 patients who underwent LT and routine PCP prophylaxis from January 2009 through December 2019 at Severance Hospital, 27 patients developed PCP. We conducted a retrospective case-control study matching each patient with four controls and analyzed the risk factors for late-onset PCP.

Results: After 6 months, post-transplant PCP cases increased steadily with an overall incidence of 6.36 cases per 1000 patient-year. The PCP-related mortality was 37.0%. In the multivariate analyses, age at LT ≥65 years (odds ratio [OR], 13.305; 95% confidence interval [CI], 2.507-70.618; P = 0.002), cytomegalovirus infection (OR, 5.390; 95% CI, 1.602-18.132; P = 0.006), steroid pulse therapy (OR, 6.564; 95% CI, 1.984-21.719; P = 0.002), hepatocellular carcinoma recurrence (OR, 18.180; 95% CI, 3.420-96.636; P = 0.001), and lymphocytopenia (OR, 3.758; 95% CI, 1.176-12.013; P = 0.026) were independently associated with PCP.

Conclusion: Late-onset PCP after routine prophylaxis after LT remains a lethal infection and is associated with age ≥65 years at LT, cytomegalovirus infection, steroid pulse therapy, hepatocellular carcinoma recurrence, and lymphocytopenia. Targeted prophylaxis considering these risk factors could improve the prevention of this potentially lethal complication.

논문정보

형식Research article
게재일2023년 06월 (BRIC 등록일 2023-06-14)
연구진국내 연구진
분야 의약학 > 응용의학

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