The following is a summary of “Risk factors for late-onset Pneumocystis jirovecii pneumonia in liver transplant recipients,” published in the June 2023 issue of the Infectious Disease by Min et al.

Not enough is known about the risk factors for late-onset Pneumocystis jirovecii pneumonia (PCP) after liver transplantation (LT). Researchers examined the clinical characteristics preceding PCP in LT recipients to inform individualized prophylaxis. About 27 of 742 patients who underwent LT and routine PCP prophylaxis at Severance Hospital between January 2009 and December 2019 developed PCP. 

In a retrospective case-control study, they matched each patient with four controls and analyzed the risk factors for late-onset PCP. After 6 months, post-transplant PCP cases increased continuously to 6.36 per 1,000 patient years. Mortality due to PCP was 37.0%. In the multivariate analyses, age at LT ≥65 years (odds ratio [OR], 13.305; 95% CI, 2.507-70.618; P = 0.002), cytomegalovirus infection (OR, 5.390; 95% CI, 1.602-18.132; P = 0.006), steroid pulse therapy (OR, 6.564; 95% CI, 1.984-21.719; P = 0.002), hepatocellular carcinoma recurrence (OR, 18.180; 95% CI, 3.420-96.636; P = 0.001), and lymphocytopenia (OR, 3.758; 95% CI, 1.176-12.013; P = 0.026) were independently associated with PCP. 

Late-onset PCP after routine prophylaxis after LT remains a fatal infection associated with age  ≥65 years at LT, cytomegalovirus infection, steroid pulse therapy, recurrence of hepatocellular carcinoma, and lymphocytopenia. This potentially fatal complication could be prevented more effectively with targeted prophylaxis that considers these risk factors.

Source: sciencedirect.com/science/article/pii/S1201971223005167