BACKGROUND Pneumocystis pneumonia (PCP) is associated with morbidity and mortality in solid organ transplant (SOT) recipients. In this case-control study, we determined the association between posttransplant PCP and 3 variables: cytomegalovirus (CMV) infection, allograft rejection, and prophylaxis. METHODS Eight transplant centers participated. For each case (SOT recipient with PCP), 3-5 controls (SOT recipients without PCP) were included. Controls were matched to the cases based on transplant center, type of allograft, and date of transplantation (±6 months). RESULTS We enrolled 53 cases and 209 controls. Transplant types included kidney (n = 198), heart (n = 30), liver (n = 15), kidney-pancreas (n = 14), and lung (n = 5). PCP occurred beyond 12 months after transplantation in 43 (81.1%) cases. Thirty-four cases (64.1%) required admission to the intensive care unit, and 28 (52.8%) had mechanical ventilation. Allograft failure occurred in 20 (37.7%) cases, and 14 (26.9%) died. No patient developed PCP prophylaxis breakthrough. The proportion of female sex (P = .009), kidney dysfunction (P = .001), cardiac diseases (P = .005), diabetes mellitus (P = .03), allograft rejection (P = .001), CMV infection (P = .001), and severe lymphopenia (P = .001) were significantly higher in cases. In the logistic regression model, CMV infection (adjusted odds ratio [aOR], 4.6 [95% confidence interval {CI}, 2.0-10.5]) and allograft rejection (aOR, 3.0 [95% CI, 1.5-6.1]) significantly increased the likelihood of PCP. CONCLUSIONS PCP was mostly a late-onset disease occurring after complete course of prophylaxis, particularly among patients with CMV infection or allograft rejection. PCP is associated with significant allograft loss. Extended prophylaxis targeting recipients with allograft rejection or CMV infection may reduce the risk of PCP.

中文翻译：

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急性排斥反应和巨细胞病毒感染对实体器官移植受者肺囊虫性肺炎影响的多中心病例对照研究。

背景技术肺囊虫性肺炎（PCP）与实体器官移植（SOT）接受者的发病率和死亡率有关。在这个病例对照研究中，我们确定了移植后PCP与3个变量之间的关联：巨细胞病毒（CMV）感染，同种异体移植排斥和预防。方法有八个移植中心参加。对于每种情况（具有PCP的SOT收件人），包括3-5个对照（不具有PCP的SOT收件人）。对照根据移植中心，同种异体移植类型和移植日期（±6个月）与病例匹配。结果我们纳入了53个病例和209个对照。移植类型包括肾脏（n = 198），心脏（n = 30），肝脏（n = 15），肾-胰腺（n = 14）和肺（n = 5）。PCP发生于移植后12个月以上，有43例（81.1％）。三十四宗（64。1％的人需要进入重症监护病房，其中28例（52.8％）的患者需要机械通气。同种异体移植失败发生20例（37.7％），死亡14例（26.9％）。没有患者开发出预防PCP的突破。女性比例（P = .009），肾功能不全（P = .001），心脏病（P = .005），糖尿病（P = .03），同种异体移植排斥（P = .001），CMV感染（P = .001），严重的淋巴细胞减少症（P = .001）明显更高。在逻辑回归模型中，CMV感染（校正比值比[aOR]，4.6 [95％置信区间{CI}，2.0-10.5]）和同种异体移植排斥反应（aOR，3.0 [95％CI，1.5-6.1]）显着增加PCP的可能性。结论PCP主要是在完全预防后发生的迟发性疾病，特别是在CMV感染或同种异体排斥反应的患者中。PCP与大量同种异体移植相关。以同种异体移植排斥或CMV感染为目标的接受者的长期预防可能会降低PCP的风险。