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Is Routine Prophylaxis Against Pneumocystis jirovecii Needed in Liver Transplantation? A Retrospective Single-Centre Experience and Current Prophylaxis Strategies in Spain

Authors :
José Ignacio Fortea
Antonio Cuadrado
Ángela Puente
Paloma Álvarez Fernández
Patricia Huelin
Carmen Álvarez Tato
Inés García Carrera
Marina Cobreros
María Luisa Cagigal Cobo
Jorge Calvo Montes
Carlos Ruiz de Alegría Puig
Juan Carlos Rodríguez SanJuán
Federico José Castillo Suescun
Roberto Fernández Santiago
Juan Andrés Echeverri Cifuentes
Fernando Casafont
Javier Crespo
Emilio Fábrega
Source :
Journal of Clinical Medicine, Vol 9, Iss 11, p 3573 (2020)
Publication Year :
2020
Publisher :
MDPI AG, 2020.

Abstract

In liver transplant (LT) recipients, Pneumocystis jirovecii pneumonia (PJP) is most frequently reported before 1992 when immunosuppressive regimens were more intense. It is uncertain whether universal PJP prophylaxis is still applicable in the contemporary LT setting. We aimed to examine the incidence of PJP in LT recipients followed at our institution where routine prophylaxis has never been practiced and to define the prophylaxis strategies currently employed among LT units in Spain. All LT performed from 1990 to October 2019 were retrospectively reviewed and Spanish LT units were queried via email to specify their current prophylaxis strategy. During the study period, 662 LT procedures were carried out on 610 patients. Five cases of PJP were identified, with only one occurring within the first 6 months. The cumulative incidence and incidence rate were 0.82% and 0.99 cases per 1000 person transplant years. All LT units responded, the majority of which provide prophylaxis (80%). Duration of prophylaxis, however, varied significantly. The low incidence of PJP in our unprophylaxed cohort, with most cases occurring beyond the usual recommended period of prophylaxis, questions a one-size-fits-all approach to PJP prophylaxis. A significant heterogeneity in prophylaxis strategies exists among Spanish LT centres.

Details

Language :
English
ISSN :
20770383
Volume :
9
Issue :
11
Database :
Directory of Open Access Journals
Journal :
Journal of Clinical Medicine
Publication Type :
Academic Journal
Accession number :
edsdoj.42b2006ef412475da950a3e44159ed78
Document Type :
article
Full Text :
https://doi.org/10.3390/jcm9113573