Adjunctive glucocorticoid therapy for Pneumocystis jirovecii pneumonia in solid organ transplant recipients: A multicenter cohort, 2015-2020

Hosseini-Moghaddam, SM; Kothari, S; Humar, A; Albasata, H; Yetmar, ZA; Razonable, RR; Neofytos, D; D&#39;Asaro, M; Boggian, K; Hirzel, C; Khanna, N; Manuel, O; Mueller, NJ; Imlay, H; Kabbani, D; Tyagi, V; Smibert, OC; Nasra, M; Fontana, L; Obeid, KM; Apostolopoulou, A; Zhang, SX; Permpalung, N; Alhatimi, H; Silverman, MS; Guo, H; Rogers, BA; MacKenzie, E; Pisano, J; Gioia, F; Rapi, L; Prasad, GVR; Banegas, M; Alonso, CD; Doss, K; Rakita, RM; Fishman, JA

Author(s): Hosseini-Moghaddam, SM; Kothari, S; Humar, A; Albasata, H; Yetmar, ZA; Razonable, RR; Neofytos, D; D'Asaro, M; Boggian, K; Hirzel, C; Khanna, N; Manuel, O; Mueller, NJ; Imlay, H; Kabbani, D; Tyagi, V; Smibert, OC; Nasra, M; Fontana, L; Obeid, KM; Apostolopoulou, A; Zhang, SX; Permpalung, N; Alhatimi, H; Silverman, MS; Guo, H; Rogers, BA; MacKenzie, E; Pisano, J; Gioia, F; Rapi, L; Prasad, GVR; Banegas, M; Alonso, CD; Doss, K; Rakita, RM; Fishman, JA;
Details: Publication Year 2024-04,Volume 24,Issue #4,Page 653-668
Journal Title: American Journal of Transplantation
Publication Type: Research article
Abstract: Solid organ transplant recipients (SOTRs) frequently receive adjunctive glucocorticoid therapy (AGT) for Pneumocystis jirovecii pneumonia (PJP). This multicenter cohort of SOTRs with PJP admitted to 20 transplant centers in Canada, the United States, Europe, and Australia, was examined for whether AGT was associated with a lower rate of all-cause intensive care unit (ICU) admission, 90-day death, or a composite outcome (ICU admission or death). Of 172 SOTRs with PJP (median [IQR] age: 60 (51.5-67.0) years; 58 female [33.7%]), the ICU admission and death rates were 43.4%, and 20.8%, respectively. AGT was not associated with a reduced risk of ICU admission (adjusted odds ratio [aOR] [95% CI]: 0.49 [0.21-1.12]), death (aOR [95% CI]: 0.80 [0.30-2.17]), or the composite outcome (aOR [95% CI]: 0.97 [0.71-1.31]) in the propensity score-adjusted analysis. AGT was not significantly associated with at least 1 unit of the respiratory portion of the Sequential Organ Failure Assessment score improvement by day 5 (12/37 [32.4%] vs 39/111 [35.1%]; P = .78). We did not observe significant associations between AGT and ICU admission or death in SOTRs with PJP. Our findings should prompt a reevaluation of routine AGT administration in posttransplant PJP treatment and highlight the need for interventional studies.
Publisher: Elsevier
Keywords: Female; Humans; Middle Aged; Europe; Glucocorticoids/therapeutic use; *Organ Transplantation/adverse effects; *Pneumocystis carinii; *Pneumonia, Pneumocystis/drug therapy/etiology; Retrospective Studies; Transplant Recipients; Male; Aged; Pneumocystis jirovecii; Pneumocystis pneumonia; solid organ transplantation
Department(s): Infectious Diseases
Publisher's Version: https://doi.org/10.1016/j.ajt.2023.11.003
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2024-07-09 08:03:33

Last Modified: 2024-07-09 08:03:41