Long-term prophylaxis for Pneumocystis jiroveci pneumonia (PCP) may be indicated for renal transplant recipients with persistent severe lymphocytopenia, according to researchers in the Netherlands.
The investigators, who noted that PCP is an important cause of morbidity and mortality in these patients, studied 27 renal transplant patients: nine who experienced PCP during a cluster outbreak at a renal transplant unit (cases) and 18 who did not (controls). All patients received their transplant in the same time period and had a similar follow-up and comparable immunosuppressive drug regimen, the investigators reported online in Nephrology Dialysis Transplantation.
The researchers, led by Geertrude H. Struijk, MD, of the University of Amsterdam, observed no significant differences in age, gender, donor type, or number of rejections between cases and controls. Case patients had a median time from transplantation to PCP of 19 months. The median lymphocyte count just before PCP diagnosis was 0.49, which was significantly lower than that of controls (median 1.36) after a similar follow-up period. This lymphocytopenia was chronic and existed in most PCP patients for many months, the authors noted. PCP patients also had significantly reduced CD4+ T-cell counts.