Risk factors for Pneumocystis jiroveci pneumonia (PcP) in renal transplant recipients.
BACKGROUND
Pneumocystis jiroveci pneumonia (PcP) is a potentially life-threatening complication in renal transplant recipients with increased reports during the past few years. Individual risk factors for susceptibility to PcP are incompletely understood.


METHODS
We retrospectively analysed 60 cases of confirmed PcP, diagnosed in six German transplant centres between 2004 and 2008, as well as 60 matched controls.


RESULTS
Compared with controls, PcP cases revealed the following significant differences: PcP cases had a poorer renal function (eGFR 31 vs. 42 mL/min in controls), more biopsy-proven rejections (18 vs. 5 patients), more frequent treatment with mycophenolate mofetil (53 vs. 44 patients) and less frequent treatment with interleukin-2 receptor antagonist (20 vs. 32 patients). According to centre policy, in those years, none of the patients or controls had received PcP prophylaxis after transplantation. Of the 60 patients with PcP, 30% developed the disease after the currently recommended duration of prophylactic treatment, 27% died in the course of the disease and 45% required treatment in the ICU.


CONCLUSIONS
Our case-control study reveals a novel risk profile for PcP. Renal transplant recipients with more pronounced renal insufficiency following rejection episodes and treated with intensified immunosuppression are at particular risk for PcP.
Division of Nephrology and Immunology, Rheinisch-Westfälische Technische Hochschule Aachen, Germany. feitner@ukaachen.de
Frank
F
Eitner
Ingeborg A
IA
Hauser
Olaf
O
Rettkowski
Thomas
T
Rath
Kai
K
Lopau
Rainer U
RU
Pliquett
Roman
R
Fiedler
Markus
M
Guba
Ralf-Dieter
RD
Hilgers
Jürgen
J
Floege
Michael
M
Fischereder
D016022:Case-Control Studies; D004196:Disease Outbreaks; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016720:Pneumocystis Infections / Q000209:etiology*; D045363:Pneumocystis carinii / Q000235:genetics / Q000302:isolation & purification*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate