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Risk factors for late-onset Pneumocystis jirovecii pneumonia in liver transplant recipients

Authors
 Eun-Ki Min  ;  Juhan Lee  ;  Su Jin Jeong  ;  Deok-Gie Kim  ;  Seung Hyuk Yim  ;  Mun Chae Choi  ;  Dong Jin Joo  ;  Myoung Soo Kim  ;  Jae Geun Lee 
Citation
 INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES, Vol.131 : 166-172, 2023-06 
Journal Title
INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES
ISSN
 1201-9712 
Issue Date
2023-06
MeSH
Aged ; Carcinoma, Hepatocellular* ; Case-Control Studies ; Cytomegalovirus Infections* / complications ; Humans ; Liver Neoplasms* ; Liver Transplantation* / adverse effects ; Lymphopenia* ; Pneumocystis carinii* ; Pneumonia, Pneumocystis* / drug therapy ; Retrospective Studies ; Risk Factors ; Steroids / therapeutic use ; Transplant Recipients
Keywords
Liver transplantation ; Pneumocystis jirovecii pneumonia ; Risk factor
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.
Files in This Item:
T202302955.pdf Download
DOI
10.1016/j.ijid.2023.04.387
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Deok Gie(김덕기)
Kim, Myoung Soo(김명수) ORCID logo https://orcid.org/0000-0002-8975-8381
Min, Eun-Ki(민은기)
Lee, Jae Geun(이재근) ORCID logo https://orcid.org/0000-0002-6722-0257
Lee, Ju Han(이주한)
Yim, Seung Hyuk(임승혁) ORCID logo https://orcid.org/0000-0003-2146-3592
Jeong, Su Jin(정수진) ORCID logo https://orcid.org/0000-0003-4025-4542
Joo, Dong Jin(주동진) ORCID logo https://orcid.org/0000-0001-8405-1531
Choi, Mun Chae(최문채)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/195335
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