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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

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 inciden...

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Detalles Bibliográficos
Autores principales: Fortea, José Ignacio, Cuadrado, Antonio, Puente, Ángela, Álvarez Fernández, Paloma, Huelin, Patricia, Álvarez Tato, Carmen, García Carrera, Inés, Cobreros, Marina, Cagigal Cobo, María Luisa, Calvo Montes, Jorge, Ruiz de Alegría Puig, Carlos, Rodríguez SanJuán, Juan Carlos, Castillo Suescun, Federico José, Fernández Santiago, Roberto, Echeverri Cifuentes, Juan Andrés, Casafont, Fernando, Crespo, Javier, Fábrega, Emilio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7694638/
https://www.ncbi.nlm.nih.gov/pubmed/33171962
http://dx.doi.org/10.3390/jcm9113573
Descripción
Sumario: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.