Logo Annals of Transplantation Logo Annals of Transplantation Logo Annals of Transplantation

06 December 2019 : Original article  

Impact of Increased Duration of Trimethoprim-Sulfamethoxazole Prophylaxis for Pneumocystis Pneumonia After Renal Transplant

Fiona A. Chapman1ABCDEF, Jonathan E. Dickerson1BC, Conal Daly1ADE, Marc Clancy1ACDE, Colin Geddes1ABCDEF*

DOI: 10.12659/AOT.918195

Ann Transplant 2019; 24:625-630


BACKGROUND: Trimethoprim-sulfamethoxazole (TMP-SMX) is recommended as prophylaxis against Pneumocystis pneumonia (PCP) in renal transplant recipients. The optimal duration of prophylaxis is unknown. Longer duration of prophylaxis may increase the risk of adverse effects. The aim of this retrospective observational cohort study was to assess the impact of increasing duration of TMP-SMX prophylaxis from 3 to 6 months after transplant on drug-resistant urinary tract infection (UTI), hyperkalemia, peripheral blood cytopenias, and incidence of PCP.

MATERIAL AND METHODS: Patients transplanted over a 4.5-year period before and after a change in protocol from 3- to 6-months TMP-SMX prophylaxis in our unit were grouped according to planned duration of prophylaxis, and results were analyzed on an intention-to-treat basis. Baseline characteristics, laboratory values, and all urine microbiology results in the 6 months after transplant were analyzed.

RESULTS: The overall UTI incidence rate was higher in the 3-month (3-m) treatment group than the 6-month (6-m) treatment group (0.52 vs. 0.33 UTI per 100 patient days; rate ratio 1.56 [95% CI 1.27–1.95]). However, this was not attributable to TMP-SMX: the incidences were significantly different in months 0–3 but not months 4–6. Twenty-eight multi-resistant UTIs occurred in the 3-m group, but there were none in the 6-m group (p=0.004). There were no significant differences in renal function, serum potassium, or cytopenias during the first 6 months. There were 15 cases of PCP in the 3-m group, 3 cases in the 6-m group, and no cases during prophylaxis.

CONCLUSIONS: Extending the duration of TMP-SMX prophylaxis was not associated with change in frequency of UTIs or multi-drug-resistant UTIs, nor was it associated with increased adverse events. TMP-SMX is an effective PCP prophylaxis, and these data support recommendations to extend the duration of prophylaxis after transplant.

Keywords: Antibiotic Prophylaxis, Drug-Related Side Effects and Adverse Reactions, Kidney Transplantation, Pneumocystis carinii, Trimethoprim-Sulfamethoxazole Combination, Urinary Tract Infections, Anti-Bacterial Agents, Cohort Studies, Drug Administration Schedule, Hematologic Diseases, Hyperkalemia, Middle Aged, Pneumonia, Pneumocystis, Retrospective Studies, Time Factors

Add Comment 0 Comments

1018 27

In Press

10 Nov 2023 : Original article  

Effects of Preservation of Donor Liver Gastroduodenal Artery on Post-Transplant Biliary Complications in 18...

Ann Transplant In Press; DOI:  

07 Nov 2023 : Original article  

Allogeneic Hematopoietic Stem Cell Transplantation Can Improve Prognosis of Extramedullary Infiltration Pos...

Ann Transplant In Press; DOI:  

06 Nov 2023 : Original article  

Clinical Outcomes of Administration of Rituximab for Desensitization in Liver Transplant Patients with Pref...

Ann Transplant In Press; DOI:  

06 Nov 2023 : Original article  

Short-Term Monitoring of Graft Regeneration in Partial Liver Transplantation Recipients

Ann Transplant In Press; DOI:  

Most Viewed Current Articles

24 Aug 2021 : Review article  

Normothermic Machine Perfusion (NMP) of the Liver – Current Status and Future Perspectives

DOI :10.12659/AOT.931664

Ann Transplant 2021; 26:e931664

26 Jan 2022 : Review article  

Recurrence of Hepatocellular Carcinoma After Liver Transplantation: Risk Factors and Predictive Models

DOI :10.12659/AOT.934924

Ann Transplant 2022; 27:e934924

29 Dec 2021 : Original article  

Efficacy and Safety of Tacrolimus-Based Maintenance Regimens in De Novo Kidney Transplant Recipients: A Sys...

DOI :10.12659/AOT.933588

Ann Transplant 2021; 26:e933588

15 Mar 2022 : Case report  

Combined Liver, Pancreas-Duodenum, and Kidney Transplantation for Patients with Hepatitis B Cirrhosis, Urem...

DOI :10.12659/AOT.935860

Ann Transplant 2022; 27:e935860

Your Privacy

We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website, You can decise for yourself which categories you you want to deny or allow. Please note that based on your settings not all functionalities of the site are available. View our privacy policy.

Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358