Pneumocystis pneumonia occurrence and prophylaxis duration in kidney transplant recipients according to perioperative treatment with rituximab.

Abstract

BACKGROUND:

Pneumocystis pneumonia (PCP) is a life-threatening fungal infection that can occur in kidney transplantation (KT) recipients. A growing number of KT recipients are receiving perioperative treatment with rituximab, which is associated with prolonged B-cell depletion and possible risk of PCP occurrence; however, the optimal prophylaxis duration according to rituximab treatment is yet unknown. We compared the occurrence of PCP and the duration of prophylaxis in KT recipients according to rituximab treatment.

METHODS:

We retrospectively analyzed 2110 patients who underwent KT between January 2009 and December 2016, who were divided into non-Rituximab group (n = 1588, 75.3%) and rituximab group (n = 522, 24.7%).

RESULTS:

In the rituximab group, the estimated number needed to treat (NNT) for prophylaxis prolongation from 6 to 12 months was 29.0 with a relative risk reduction of 90.0%. In the non-rituximab group, the estimated NNT value was 133.3 and the relative risk reduction was 66.4%. Rituximab treatment (hazard ratio (HR) = 3.09; P <  0.01) and acute rejection (HR = 2.19; P = 0.03) were significant risk factors for PCP in multivariate analysis.

CONCLUSIONS:

Our results suggest that maintaining PCP prophylaxis for 12 months may be beneficial in KT recipients treated with rituximab for desensitization or acute rejection treatment.

• Authors: Young Hoon Kim, Jee Yeon Kim, Dong Hyun Kim, Youngmin Ko, Ji Yoon Choi, Sung Shin, Joo Hee Jung, Su-Kil Park, Sung-Han Kim, Hyunwook Kwon, Duck Jong Han
• Journal: BMC nephrology (BMC Nephrol) Vol. 21 Issue 1 Pg. 93 (03 11 2020) ISSN: 1471-2369 [Electronic] England
• PMID: 32160881 (Publication Type: Journal Article)

Chemical References

• Immunosuppressive Agents
• Rituximab

Topics

• Adult
• B-Lymphocytes (drug effects)
• Drug Administration Schedule
• Female
• Graft Rejection
• Humans
• Immunocompromised Host
• Immunosuppressive Agents (administration & dosage, adverse effects)
• Kidney Transplantation (adverse effects)
• Male
• Middle Aged
• Opportunistic Infections (prevention & control)
• Perioperative Period
• Pneumonia, Pneumocystis (prevention & control)
• Postoperative Complications (prevention & control)
• Renal Insufficiency, Chronic (surgery)
• Retrospective Studies
• Risk Factors
• Rituximab (administration & dosage, adverse effects)