PMID- 12974789
OWN - NLM
STAT- MEDLINE
DCOM- 20031211
LR  - 20220311
IS  - 1398-2273 (Print)
IS  - 1398-2273 (Linking)
VI  - 5
IP  - 2
DP  - 2003 Jun
TI  - Risk factors for Pneumocystis carinii pneumonia in kidney transplant recipients: 
      a case-control study.
PG  - 84-93
AB  - OBJECTIVE: To analyze risk factors for Pneumocystis carinii pneumonia (PCP) in 
      kidney transplant recipients. STUDY DESIGN: In a case-control study, 17 PCP cases 
      diagnosed between July 1994 and July 2000 were matched with two controls each 
      (previous and subsequent kidney transplant recipients who did not develop PCP 
      during the same follow-up period). Demographics, organ origin, human leukocyte 
      antigen (HLA) mismatches, use of poly- or monoclonal anti-CD3 antibodies 
      (Po/MoAb) for induction or rejection treatment, rejection episodes, cumulative 
      steroid dose for rejection treatment, immunosuppressive regimens, and other 
      infections were analyzed. RESULTS: No significant differences were seen in gender 
      (male 10 vs. 15), mean age (39.7 vs. 35.4 years), organ origin (cadaver donor 13 
      vs. 19), HLA mismatches, or Po/MoAb use in induction treatment. Significant 
      differences were observed in PCP cases for rejection history (P=0.02), and median 
      and total number of rejection episodes (P=0.0018). The relative risks for PCP for 
      1, 2, and > or =3 rejection treatments vs. no such treatment were 1, 1.05, and 
      6.30, respectively (P=0.021). The relative risk for PCP for steroid-resistant 
      rejection was 4.34 (95% confidence interval [CI], 1.04-18.89) (P=0.019), and that 
      for the use of Po/MoAb for rejection treatment was 7.23 (95% CI, 1.28-49.34) 
      (P=0.006). The relative risk for PCP for 0, 1, and > or =2 previous or 
      concomitant cytomegalovirus (CMV) infection vs. no such infections were 1.0, 
      2.32, and 13.0, respectively (P=0.012). The relative risks for PCP for 
      tuberculosis (TB) was 18 (95% CI, 1.76-852.03), that for bacterial pneumonia was 
      14.22 (95% CI, 2.16-150.23), and that for hepatitis C virus infection was 5.25 
      (95% CI, 1.03-28.91). Immunosuppressive regimens with tacrolimus, mycophenolate 
      mofetil (MMF), steroids (P=0.06), and MMF as a single variable (P=0.05) were more 
      frequently used in cases. Primary trimethoprim-sulfamethoxazole prophylaxis 
      failure was observed in 12 patients in association with heavy immunosuppression 
      and concomitant infections. CONCLUSIONS: The risk of PCP in kidney transplant 
      recipients is related to the number and type of rejection treatments. It is also 
      related to the occurrence of CMV infection, and to other immunomodulating 
      infections such as TB and hepatitis C, and might also be increased with the use 
      of newer and more potent immunosuppressive agents. Primary prophylaxis failure 
      may occur in association with some of these risk factors.
FAU - Radisic, M
AU  - Radisic M
AD  - Instituto de Nefrologia, Cabello 3889, Capital Federal 1425, Buenos Aires, 
      Argentina. mradisic@intramed.net.ar
FAU - Lattes, R
AU  - Lattes R
FAU - Chapman, J F
AU  - Chapman JF
FAU - del Carmen Rial, M
AU  - del Carmen Rial M
FAU - Guardia, O
AU  - Guardia O
FAU - Seu, F
AU  - Seu F
FAU - Gutierrez, P
AU  - Gutierrez P
FAU - Goldberg, J
AU  - Goldberg J
FAU - Casadei, D H
AU  - Casadei DH
LA  - eng
PT  - Journal Article
PL  - Denmark
TA  - Transpl Infect Dis
JT  - Transplant infectious disease : an official journal of the Transplantation 
      Society
JID - 100883688
RN  - 0 (Immunosuppressive Agents)
SB  - IM
MH  - Adult
MH  - Case-Control Studies
MH  - Cytomegalovirus/isolation & purification
MH  - Cytomegalovirus Infections/complications/epidemiology/microbiology
MH  - Female
MH  - Graft Rejection/drug therapy
MH  - Humans
MH  - Immunosuppressive Agents/administration & dosage
MH  - Kidney Transplantation/*adverse effects
MH  - Male
MH  - Mycobacterium tuberculosis/isolation & purification
MH  - Pneumonia, Pneumocystis/*epidemiology
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Tuberculosis, Pulmonary/complications/epidemiology/microbiology
EDAT- 2003/09/17 05:00
MHDA- 2003/12/12 05:00
CRDT- 2003/09/17 05:00
PHST- 2003/09/17 05:00 [pubmed]
PHST- 2003/12/12 05:00 [medline]
PHST- 2003/09/17 05:00 [entrez]
AID - 018 [pii]
AID - 10.1034/j.1399-3062.2003.00018.x [doi]
PST - ppublish
SO  - Transpl Infect Dis. 2003 Jun;5(2):84-93. doi: 10.1034/j.1399-3062.2003.00018.x.