Background

Lung transplantation (LT) is an identified risk factor for Pneumocystis pneumonia (PCP). However, PCP management and outcomes remain poorly described in LT recipients and PCP incidence is rarely documented in this population.

Methods

PCP episodes that occurred in 9 French LT centers between January 2010 and October 2017 were included in this analysis. PCP was defined as compatible clinical and radiologic findings associated with fungal identification.

Results

Forty-seven PCP were included. The annual incidence rate of PCP was 2.7/1000 patients/year. Patients had a mean age of 53 ± 14 years. Median time from LT was 2.4 ± 3.0 years. Sixty-five percent of patients were not on prophylaxis at the time of PCP while all patients were receiving steroids at the time of PCP. Diagnosis was obtained by bronchoalveolar lavage in 91% (direct examination: 47%, PCR: 62%). The majority of patients were treated with trimethoprim-sulfamethoxazole (78%). Fifty-five percent of patients were hospitalized in ICU for organ failure (for which non-invasive ventilation was used for 21% and mechanical ventilation for 23%). Mortality rate was 15% at day 28 and reached 23% at day 90. Mortality was associated with decreased FEV1, everolimus treatment, Pseudomonas aeruginosa coinfection, fungal coinfection (especially Aspergillus sp.), mechanical ventilation and vasopressors. PCP primary prophylaxis, steroid modification during PCP and the number of immunosuppressive molecules were not associated with mortality.

Conclusion

PCP is associated with a high mortality in LT. Our data suggest the need for a lifetime PCP prophylaxis in LT recipients. The benefit of adjuvant steroids remains unclear.

中文翻译：

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肺移植后肺囊虫性肺炎：一项回顾性多中心研究。

背景

肺移植（LT）是肺囊虫性肺炎（PCP）的确定危险因素。但是，LT接受者对PCP管理和结局的描述仍然不多，该人群中很少记录到PCP发生率。

方法

该分析包括2010年1月至2017年10月在法国9个LT中心发生的PCP发作。PCP被定义为与真菌鉴定相关的可兼容的临床和影像学发现。

结果

其中包括47个PCP。PCP的年发生率为2.7 / 1000患者/年。患者平均年龄为53±14岁。LT的中位时间为2.4±3。0年。65％的患者在PCP时未进行预防，而所有患者在PCP时均接受类固醇治疗。通过支气管肺泡灌洗进行诊断的比例为91％（直接检查：47％，PCR：62％）。大多数患者接受甲氧苄氨嘧啶磺胺甲基异恶唑治疗（78％）。55％的患者因器官衰竭而在ICU住院（其中，无创通气占21％，机械通气占23％）。死亡率在第28天时为15％，在第90天时达到23％。死亡率与FEV1降低，依维莫司治疗，铜绿假单胞菌相关合并感染，真菌合并感染（尤其是曲霉菌属），机械通气和升压药。PCP的一级预防，PCP期间的类固醇修饰和免疫抑制分子的数量与死亡率无关。

结论

PCP与LT的高死亡率有关。我们的数据表明，LT接受者需要终生预防PCP。辅助类固醇的益处尚不清楚。