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Title: | Adjunctive Glucocorticoid Therapy for Pneumocystis jirovecii Pneumonia in Solid Organ Transplant Recipients: A Multicenter Cohort, 2015-2020. | Austin Authors: | Hosseini-Moghaddam, Seyed M;Kothari, Sagar;Humar, Atul;Albasata, Hanan;Yetmar, Zachary A;Razonable, Raymund R;Neofytos, Dionysios;D'Asaro, Matilde;Boggian, Katia;Hirzel, Cedric;Khanna, Nina;Manuel, Oriol;Mueller, Nicolas J;Imlay, Hannah;Kabbani, Dima;Tyagi, Varalika;Smibert, Olivia C ;Nasra, Mohamed;Fontana, Lauren;Obeid, Karam M;Apostolopoulou, Anna;Zhang, Sean X;Permpalung, Nitipong;Alhatimi, Hind;Silverman, Michael S;Guo, Henry;Rogers, Benjamin A;MacKenzie, Erica;Pisano, Jennifer;Gioia, Francesca;Rapi, Lindita;Prasad, G V Ramesh;Banegas, Marcela;Alonso, Carolyn D;Doss, Kathleen;Rakita, Robert M;Fishman, Jay A | Affiliation: | Transplant Infectious Diseases and Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada. Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA. Transplant Infectious Diseases Unit, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland. Transplant Infectious Diseases Unit, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland. Division of Infectious Diseases, Cantonal Hospital St Gallen, St Gallen, Switzerland. Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland. Division of Infectious Diseases, University Hospital of Vaud, Lausanne, Switzerland. Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, Switzerland. University of Utah, Department of Internal Medicine, Salt Lake City, UT, USA. Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. Medicine (University of Melbourne) Infectious Diseases Monash Health, Melbourne, Victoria, Australia Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, USA. Transplant Infectious Disease Program and Transplant Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Department of Medicine, Division of Infectious Diseases, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada. Monash Health, Melbourne, Victoria, Australia; School of Clinical Sciences at Monash Health, Monash University, Clayton, Vic, Australia. Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, Illinois, USA. Department of Infectious Diseases, Hospital Roman y Cajal, Madrid, Spain. Kidney Transplant Program, St. Michael Hospital, University of Toronto, Toronto, Ontario, Canada. Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA. Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA. Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA. Transplant Infectious Disease Program and Transplant Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. |
Issue Date: | Apr-2024 | Date: | 2023 | Publication information: | American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons 2024-04; 24(4) | 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, examined whether AGT was associated with a lower rate of all-cause intensive care unit (ICU) admission, 90-day in-hospital 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 (33.5%)], the ICU admission and death rates were 43.4%, and 20.8%, respectively. AGT was not associated with a reduced risk of ICU admission [aOR (CI95%): 0.49 (0.21-1.12)], death [aOR (CI95%): 0.80 (0.30-2.17)], or the composite outcome [aOR (CI95%): 10.97 (0.71-1.31)] in the propensity score-adjusted analysis. AGT was not significantly associated with at least 1-unit SOFAResp (the respiratory portion of the Sequential Organ Failure Assessment score) improvement by day 5 [12/37 (32.4%) vs 39/111 (35.1%), p=0.76)]. We did not observe significant associations between AGT and ICU admission or death in SOTRs with PJP. Our findings should prompt a re-evaluation of routine AGT administration in post-transplant PJP treatment and highlight the need for interventional studies. | URI: | https://ahro.austin.org.au/austinjspui/handle/1/34285 | DOI: | 10.1016/j.ajt.2023.11.003 | ORCID: | Journal: | American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons | PubMed URL: | 37977229 | ISSN: | 1600-6143 | Type: | Journal Article | Subjects: | Pneumocystis jirovecii pneumocystis pneumonia solid organ transplantation |
Appears in Collections: | Journal articles |
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