Kevin D He, Linh Nguyen, Maxwell Norris, Gregory Malat, Stephanie Witek, Chelsea Sammons, Abigail Forte, Tamara Claridge, Jennifer Trofe Clark, Emily Blumberg
{"title":"Alternative Pneumocystis Pneumonia Prophylaxis in Solid Organ Transplants.","authors":"Kevin D He, Linh Nguyen, Maxwell Norris, Gregory Malat, Stephanie Witek, Chelsea Sammons, Abigail Forte, Tamara Claridge, Jennifer Trofe Clark, Emily Blumberg","doi":"10.1111/tid.14410","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Despite limited data supporting use in solid organ transplant (SOT) recipients, atovaquone and dapsone are often used as alternatives to trimethoprim-sulfamethoxazole (TMP-SMX) for Pneumocystis jirovecii pneumonia (PJP) prophylaxis.</p><p><strong>Methods: </strong>This single-center, retrospective cohort study describes a multi-organ program's experience with alternative PJP prophylaxis. Adult SOT recipients transplanted November 13, 2020 to November 13, 2022 who received non-TMP-SMX PJP prophylaxis and had > 1 year follow-up were included.</p><p><strong>Results: </strong>Among 953 SOTs performed, 333 (34.9%) recipients received alternative PJP prophylaxis (319 [95.8%] atovaquone and 14 [4.2%] dapsone). Alternative prophylaxis was initiated in 76 (22.8%) recipients without starting TMP-SMX, mostly due to sulfa allergy (62, 81.6%). In 257 recipients who started TMP-SMX, common reasons for switching to alternatives were hyperkalemia (105, 40.9%) and leukopenia (77, 30.0%). While 79.8% of recipients had these adverse effects resolve, only 27.3% resumed TMP-SMX. Tolerance was high after resumption (85.7%). Barriers to accessing alternative prophylaxis included cost (25, 7.5%) and prior authorizations (26, 7.8%). There was one case of severe disseminated toxoplasmosis, one case of Nocardia infection, and no cases of PJP.</p><p><strong>Conclusion: </strong>Alternative PJP prophylaxis carries risk of breakthrough infection and barriers to initiation. Since most recovered from adverse effects of TMP-SMX and tolerated resumption, providers should re-trial TMP-SMX when feasible.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e14410"},"PeriodicalIF":2.6000,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Transplant Infectious Disease","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/tid.14410","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Despite limited data supporting use in solid organ transplant (SOT) recipients, atovaquone and dapsone are often used as alternatives to trimethoprim-sulfamethoxazole (TMP-SMX) for Pneumocystis jirovecii pneumonia (PJP) prophylaxis.
Methods: This single-center, retrospective cohort study describes a multi-organ program's experience with alternative PJP prophylaxis. Adult SOT recipients transplanted November 13, 2020 to November 13, 2022 who received non-TMP-SMX PJP prophylaxis and had > 1 year follow-up were included.
Results: Among 953 SOTs performed, 333 (34.9%) recipients received alternative PJP prophylaxis (319 [95.8%] atovaquone and 14 [4.2%] dapsone). Alternative prophylaxis was initiated in 76 (22.8%) recipients without starting TMP-SMX, mostly due to sulfa allergy (62, 81.6%). In 257 recipients who started TMP-SMX, common reasons for switching to alternatives were hyperkalemia (105, 40.9%) and leukopenia (77, 30.0%). While 79.8% of recipients had these adverse effects resolve, only 27.3% resumed TMP-SMX. Tolerance was high after resumption (85.7%). Barriers to accessing alternative prophylaxis included cost (25, 7.5%) and prior authorizations (26, 7.8%). There was one case of severe disseminated toxoplasmosis, one case of Nocardia infection, and no cases of PJP.
Conclusion: Alternative PJP prophylaxis carries risk of breakthrough infection and barriers to initiation. Since most recovered from adverse effects of TMP-SMX and tolerated resumption, providers should re-trial TMP-SMX when feasible.
期刊介绍：
Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal.
Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.
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