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Abstract: PO2087

Pneumocystis Jiroveci pneumonia in Renal Transplant Recipients: Experience at a Tertiary Care Center

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Subbiah, Arunkumar, All India Institute of Medical Sciences, New Delhi, Delhi, India
  • Agarwal, Sanjay K., All India Institute of Medical Sciences, New Delhi, Delhi, India
Background

Pneumocystis jiroveci pneumonia (PJP) is an important cause of morbidity and mortality in post renal transplant recipients. Data on PJP in renal transplant recipients from India is lacking and we have attempted to address these lacunae.

Methods

This single center retrospective study included all cases of PJP in renal transplant recipients diagnosed at our institute. Demographic, clinical, laboratory and therapeutic outcomes of all these patients were analyzed.

Results

Of the 1870 renal transplant recipient records analyzed, 37 (1.9%) recipients were diagnosed with PJP. The median age of the patients was 38 years (17-74) with 31 males (83.8%). Three (8.1%) patients had deceased donors while 34 (91.9%) had living donors. Induction on the basis of immunological risk profile was ATG in 3 patients (8.1%), daclizumab in 2(5.4%), basiliximab in 11(29.8%) and 21 patients (56.7%) received no induction. All patients received steroid based triple drug immunosuppression along with Tacrolimus in 27(72.9%), Cyclosporine in 10(27.1%), MMF in 34(91.9%) and Azathioprine in 3(8.1%.). Septran prophylaxis was given for 6 months. The median time from transplantation to infection was 11 months(1-132). Eight recipients (22%) had PJP in the first six months post-transplant. Among them, five had co-infection with CMV, three had received prior anti-rejection treatment (ART) and three were non-compliant to PJP prophylaxis. The remaining 29 patients developed PJP after cessation of septran prophylaxis. Out of 29, 9 had received ART prior to PJP infection, 11 had CMV co-infection & 5 had prior history of CMV infection. Diagnosis was microbiologically confirmed in 17 patients by PJP PCR in BAL and in others, diagnosis was made by clinic-radiological features and response to treatment. The most common clinical presentation was dyspnea in 29(78.3%) and 9(31%) required mechanical ventilation. Patients were treated with septran + steroid (9,24%); Clindamycin + steroid (4,10.8%); septran + Clindamycin + steroid (24,64.8%). Three patients (8.3%) expired during PJP infection.

Conclusion

Prophylaxis and tailored immunosuppression explains the low incidence of PJP in our center. Majority of patients had prophylaxis noncompliance, prior anti-rejection therapy or CMV infection before PJP infection. Early diagnosis and timely therapy resulted in better patient outcome.