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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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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
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author 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
author_facet 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
author_sort Fortea, José Ignacio
collection PubMed
description 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.
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spelling pubmed-76946382020-11-28 Is Routine Prophylaxis Against Pneumocystis jirovecii Needed in Liver Transplantation? A Retrospective Single-Centre Experience and Current Prophylaxis Strategies in Spain 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 J Clin Med Article 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. MDPI 2020-11-06 /pmc/articles/PMC7694638/ /pubmed/33171962 http://dx.doi.org/10.3390/jcm9113573 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
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
Is Routine Prophylaxis Against Pneumocystis jirovecii Needed in Liver Transplantation? A Retrospective Single-Centre Experience and Current Prophylaxis Strategies in Spain
title Is Routine Prophylaxis Against Pneumocystis jirovecii Needed in Liver Transplantation? A Retrospective Single-Centre Experience and Current Prophylaxis Strategies in Spain
title_full Is Routine Prophylaxis Against Pneumocystis jirovecii Needed in Liver Transplantation? A Retrospective Single-Centre Experience and Current Prophylaxis Strategies in Spain
title_fullStr Is Routine Prophylaxis Against Pneumocystis jirovecii Needed in Liver Transplantation? A Retrospective Single-Centre Experience and Current Prophylaxis Strategies in Spain
title_full_unstemmed Is Routine Prophylaxis Against Pneumocystis jirovecii Needed in Liver Transplantation? A Retrospective Single-Centre Experience and Current Prophylaxis Strategies in Spain
title_short Is Routine Prophylaxis Against Pneumocystis jirovecii Needed in Liver Transplantation? A Retrospective Single-Centre Experience and Current Prophylaxis Strategies in Spain
title_sort is routine prophylaxis against pneumocystis jirovecii needed in liver transplantation? a retrospective single-centre experience and current prophylaxis strategies in spain
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7694638/
https://www.ncbi.nlm.nih.gov/pubmed/33171962
http://dx.doi.org/10.3390/jcm9113573
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