Pneumocystis pneumonia (PCP) incidence was decreased in renal transplant thanks to prophylaxis, recommended during the first months after transplantation. However, many late PCP cases are observed after the first 6 months and recommendations to maintain or reintroduce prophylaxis are lacking. The objective of the study was to identify risk factors to guide the individual prescription of prophylaxis, 6 months after transplantation. Thirty-three late PCP cases were identified between 1995 and 2012 in Lille Hospital, France, and were compared to 72 randomized controls transplant recipients. In univariate analysis, age of donor (>48 years), retransplantation, a decrease glomerular filtration rate (≤45 mL/min), induction therapy mediated by anti-thymocyte globulin (ATG), steroid maintenance, high calcineurin inhibitors (CNI) doses (tacrolimus ≥0.5 mg/kg/day and cyclosporine ≥2.1 mg/kg/day), and cytomegalovirus (CMV) infection were significantly associated with PCP. In multivariate analysis, ATG (hazard ratio [HR]: 2.4 [1.1-5.4]), steroid therapy (HR: 3.1 [1.20-7.84], CNI (HR: 2.9 [1.28-6.38], and CMV (HR: 6.1 [2.74-16.33] remained associated with late PCP. In conclusion, we confirm that intensive immunosuppressive regimen and CMV infection are critical risk factors for late PCP and should be taken into account to decide on maintenance or reintroduction of a prophylactic treatment.

译文

:由于预防,建议在移植后的头几个月内,减少肾脏移植中肺囊虫性肺炎(PCP)的发生率。但是,在头6个月后观察到许多晚期PCP病例,缺乏维持或重新引入预防措施的建议。该研究的目的是确定危险因素,以指导移植后6个月进行预防的个体处方。在1995年至2012年之间,法国里尔医院确定了33例晚期PCP病例,并将其与72名随机对照移植受者进行了比较。在单因素分析中,供体年龄(> 48岁),再移植,肾小球滤过率降低(≤45mL / min),抗胸腺细胞球蛋白(ATG)介导的诱导治疗,类固醇维持,钙调神经磷酸酶抑制剂(CNI)剂量高他克莫司≥0.5mg / kg /天,环孢菌素≥2.1mg / kg /天)和巨细胞病毒(CMV)感染与PCP显着相关。在多变量分析中,ATG(危险比[HR]:2.4 [1.1-5.4]),类固醇治疗(HR:3.1 [1.20-7.84],CNI(HR:2.9 [1.28-6.38])和CMV(HR:6.1 [ [2.74-16.33]仍与晚期PCP相关,总的来说,我们确认强化免疫抑制方案和CMV感染是晚期PCP的关键危险因素,应考虑维持或重新引入预防性治疗。

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