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Is Routine Prophylaxis Against Pneumocystis jirovecii Needed in Liver Transplantation? A Retrospective Single-Centre Experience and Current Prophylaxis Strategies in Spain

1
Gastroenterology and Hepatology Department, University Hospital Marqués de Valdecilla, 39008 Santander, Spain
2
Group of Clinical and Translational Research in Digestive Diseases, Health Research Institute Marqués de Valdecilla (IDIVAL), 39011 Santander, Spain
3
Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBERehd), 28029 Madrid, Spain
4
Department of Pathological Anatomy, University Hospital Marqués de Valdecilla. 39008 Santander, Spain
5
Department of Microbiology, University Hospital Marqués de Valdecilla, 39008 Santander, Spain
6
Department of General Surgery, University Hospital Marqués de Valdecilla, 39008 Santander, Spain
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(11), 3573; https://doi.org/10.3390/jcm9113573
Received: 6 October 2020 / Revised: 2 November 2020 / Accepted: 4 November 2020 / Published: 6 November 2020
(This article belongs to the Special Issue Liver Transplantation: Improving Results under Worsening Conditions)
In liver transplant (LT) recipients, Pneumocystis jirovecii pneumonia (PJP) is most frequently reported before 1992 when immunosuppressive regimens were more intense. It is uncertain whether universal PJP prophylaxis is still applicable in the contemporary LT setting. We aimed to examine the incidence of PJP in LT recipients followed at our institution where routine prophylaxis has never been practiced and to define the prophylaxis strategies currently employed among LT units in Spain. All LT performed from 1990 to October 2019 were retrospectively reviewed and Spanish LT units were queried via email to specify their current prophylaxis strategy. During the study period, 662 LT procedures were carried out on 610 patients. Five cases of PJP were identified, with only one occurring within the first 6 months. The cumulative incidence and incidence rate were 0.82% and 0.99 cases per 1000 person transplant years. All LT units responded, the majority of which provide prophylaxis (80%). Duration of prophylaxis, however, varied significantly. The low incidence of PJP in our unprophylaxed cohort, with most cases occurring beyond the usual recommended period of prophylaxis, questions a one-size-fits-all approach to PJP prophylaxis. A significant heterogeneity in prophylaxis strategies exists among Spanish LT centres. View Full-Text
Keywords: Prophylaxis; Pneumocystis jirovecii; liver transplantation Prophylaxis; Pneumocystis jirovecii; liver transplantation
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MDPI and ACS Style

Fortea, J.I.; Cuadrado, A.; Puente, Á.; Álvarez Fernández, P.; Huelin, P.; Álvarez Tato, C.; García Carrera, I.; Cobreros, M.; Cagigal Cobo, M.L.; Calvo Montes, J.; Ruiz de Alegría Puig, C.; Rodríguez SanJuán, J.C.; Castillo Suescun, F.J.; Fernández Santiago, R.; Echeverri Cifuentes, J.A.; Casafont, F.; Crespo, J.; Fábrega, E. Is Routine Prophylaxis Against Pneumocystis jirovecii Needed in Liver Transplantation? A Retrospective Single-Centre Experience and Current Prophylaxis Strategies in Spain. J. Clin. Med. 2020, 9, 3573. https://doi.org/10.3390/jcm9113573

AMA Style

Fortea JI, Cuadrado A, Puente Á, Álvarez Fernández P, Huelin P, Álvarez Tato C, García Carrera I, Cobreros M, Cagigal Cobo ML, Calvo Montes J, Ruiz de Alegría Puig C, Rodríguez SanJuán JC, Castillo Suescun FJ, Fernández Santiago R, Echeverri Cifuentes JA, Casafont F, Crespo J, Fábrega E. Is Routine Prophylaxis Against Pneumocystis jirovecii Needed in Liver Transplantation? A Retrospective Single-Centre Experience and Current Prophylaxis Strategies in Spain. Journal of Clinical Medicine. 2020; 9(11):3573. https://doi.org/10.3390/jcm9113573

Chicago/Turabian Style

Fortea, José Ignacio, Antonio Cuadrado, Ángela Puente, Paloma Álvarez Fernández, Patricia Huelin, Carmen Álvarez Tato, Inés García Carrera, Marina Cobreros, María Luisa Cagigal Cobo, Jorge Calvo Montes, Carlos Ruiz de Alegría Puig, Juan Carlos Rodríguez SanJuán, Federico José Castillo Suescun, Roberto Fernández Santiago, Juan Andrés Echeverri Cifuentes, Fernando Casafont, Javier Crespo, and Emilio Fábrega. 2020. "Is Routine Prophylaxis Against Pneumocystis jirovecii Needed in Liver Transplantation? A Retrospective Single-Centre Experience and Current Prophylaxis Strategies in Spain" Journal of Clinical Medicine 9, no. 11: 3573. https://doi.org/10.3390/jcm9113573

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