title: Clinical outcomes of Pneumocystis carinii pneumonia in adult liver transplant recipients.
abstract: OBJECTIVE
  Pneumocystis carinii pneumonia (PCP) is an opportunistic infection associated with morbidity and mortality in solid-organ transplant recipients. We retrospectively assessed the characteristics and outcomes of liver transplant (OLT) recipients with PCP compared with those of patients with severe non-P carinii pneumonia (non-PCP) who required intensive care with mechanical ventilation.
  
  
  METHODS
  During the 2-year period between January 2008 and December 2009, 43 adult OLT recipients had severe pneumonia requiring mechanical ventilation; of these, 8 (19%) had PCP. During this period, routine antibiotic prophylaxis was administered for the first 6 months after OLT.
  
  
  RESULTS
  The median period from OLT to development of PCP was 9.5 months (range, 1-67); the 1-year incidence was 0.9%. The 6 and 6 to 12-month incidences of non-PCP were 4.2% and 0.3%, respectively, and those of PCP were 0.3% and 0.6%, respectively. Four of 8 patients (50%) in the PCP group had a recent history of a rejection episode. PCP was associated with a higher incidence of prior antirejection treatment. There were no significant differences between PCP and non-PCP groups in age, gender, preoperative Model for End-stage Liver Disease score, primary diagnosis, graft type, and total number of rejection episodes.
  
  
  CONCLUSIONS
  These results indicate that the risk of PCP in OLT recipients is closely related to strong immunosuppressive treatment for acute cellular rejection episodes, suggesting the importance of PCP prophylaxis in these patients. Because most patients developed PCP at around 1 year, it may be advisable to prolong routine post-OLT PCP prophylaxis for 12 months, especially among patients receiving antirejection treatment.
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Y-I
authors.initials: YI
authors.lastname: Choi
authors.forename: S
authors.initials: S
authors.lastname: Hwang
authors.forename: G-C
authors.initials: GC
authors.lastname: Park
authors.forename: J-M
authors.initials: JM
authors.lastname: Namgoong
authors.forename: D-H
authors.initials: DH
authors.lastname: Jung
authors.forename: G-W
authors.initials: GW
authors.lastname: Song
authors.forename: T-Y
authors.initials: TY
authors.lastname: Ha
authors.forename: D-B
authors.initials: DB
authors.lastname: Moon
authors.forename: K-H
authors.initials: KH
authors.lastname: Kim
authors.forename: C-S
authors.initials: CS
authors.lastname: Ahn
authors.forename: S-G
authors.initials: SG
authors.lastname: Lee
mesh_terms: D019072:Antibiotic Prophylaxis; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011020:Pneumonia, Pneumocystis / Q000628:therapy*; D015996:Survival Rate