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Proposal of a Selective Prophylaxis Strategy Based on Risk Factors to Prevent Early and Late Pneumocystis jirovecii Pneumonia after Renal Transplantation
J Korean Soc Transplant 2018;32:92-103
Published online December 31, 2018
© 2018 The Korean Society for Transplantation.

Ho Lee, M.D.1, Ahram Han, M.D.1, Chanjoong Choi, M.D.1, Sanghyun Ahn, M.D.1, Sang-il Min, M.D.1, Seung-Kee Min, M.D.1, Hajeong Lee, M.D.2, Yon Su Kim, M.D.2, Jaeseok Yang, M.D.1,3 and Jongwon Ha, M.D.1,3

Departments of Surgery1, Internal Medicine2, Transplantation Research Institute3,
Seoul National University College of Medicine, Seoul, Korea
Correspondence to: Jongwon Ha
Department of Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
Tel: 82-2-2072-2991, Fax: 82-2-766-3975
Received October 18, 2018; Revised October 29, 2018; Accepted October 29, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Currently, trimethoprim-sulfamethoxazole is used for Pneumocystis jirovecii pneumonia (PJP) prophylaxis, but it is associated with frequent adverse effects. This study evaluated the efficacy and safety of the current protocol and proposes an individualized risk-based prophylaxis protocol.
Methods: The PJP incidence and risk factors during the first 6 months (early PJP) and afterwards (late PJP) was assessed in renal transplant recipients with (prophylaxis group) and without (no-prophylaxis group) 6-month PJP prophylaxis.
Results: In 578 patients, there were 39 cases of PJP during a median follow-up of 51 months. Renal adverse events were encountered frequently during trimethoprim-sulfamethoxazole prophylaxis, leading to premature discontinuation. Patients without the prophylaxis had a significantly higher incidence of early PJP (n=27, 6.6%) compared to patients with the prophylaxis (n=0). The incidence of late PJP was 2.2%, without between-group differences. The factors associated with early PJP were preoperative desensitization and acute rejection within 1 month, whereas late PJP was associated with age, deceased donor transplant, and acute rejection requiring antithymocyte globulin treatment.
Conclusions: Based on the simulation results of several risk-based scenarios, the authors recommend universal prophylaxis up to 6 months post-transplant and extended selective prophylaxis in patients aged ≥57 years and those with a transplant from deceased donors.
Keywords : Selective prophylaxis, Kidney transplantation, Pneumocystis jirovecii pneumonia

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