Patients receiving lung transplants who had pneumocystis pneumonia had higher mortality rates than patients without pneumocystis pneumonia, according to study results published in Respiratory Medicine.

Clinical end points from medical records of patients receiving lung transplants with pneumocystis pneumonia at a French hospital were retrospectively analyzed. Positive diagnosis was confirmed via the presence of suggestive symptoms, compatible radiologic findings, or a positive microbiological diagnostic test. The primary study outcome was mortality at day 90 after pneumocystis pneumonia diagnosis. Secondary outcomes were mortality at day 28 and pneumocystis pneumonia incidence rate.

Of the 50 patient records screened for study inclusion, 3 were excluded for not meeting inclusion/exclusion criteria. Ultimately, 47 cases of pneumocystis pneumonia occurring in 45 adults were analyzed. The incidence rate of pneumocystis pneumonia was 2.7 per 1000 patients per year. A total of 55% of patients with pneumocystis pneumonia were hospitalized in an intensive care unit, of whom 78% experienced organ failure. In the primary study outcome, the mortality rate was 15% at day 28 and reached 23% at day 90.

Mortality was associated decreased forced expiratory volume in 1 second, coinfection with Pseudomonas aeruginosa, fungal coinfection, mechanical ventilation, and vasopressors.


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“Our data suggest the need for a lifetime [pneumocystis pneumonia] prophylaxis in lung transplant recipients,” the study authors wrote. Although, they added, “the benefit of adjuvant steroids remains unclear.”

Disclosure: A study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Delbove A, Alami H, Tissot A, et al. Pneumocystis pneumonia after lung transplantation: a retrospective multicenter study [published online May 12, 2020]. Respir Med. doi:10.1016/j.rmed.2020.106019