Pneumocystis jirovecii is a fungus responsible for potentially lethal opportunistic acute pulmonary infections in immune-depressed patients, particularly through solid organ transplantation. Current data in the literature are poor in the subpopulation of lung transplant patients.

We have designed a retrospective multi-center study in 9 lung transplant centers in France to include 47 patients who developed pneumocystis after transplantation between January 2010 and October 2017. The etiologies of the transplants were diverse.

The minimum incidence was estimated at 2.7/1000 patients/year. Only 64% of the patients were on prophylaxis prior to the episode. The delay between infection and transplantation ranged from 7 days to 25 years, arguing for early and lifelong drug prophylaxis. All patients were on several immunosuppressive drugs including corticosteroids. In 91% of cases, microbiological diagnosis was made by PCR in bronchoalveolar lavage. Co-infections were frequent (67%), mainly respiratory.

More than half of the cases were hospitalized in intensive care. Mortality was 23% at D+90. The curative treatment was trimethoprim-sulfamethoxazole in 78% of cases. The management of corticosteroid therapy during the episode was variable, with no significant association with prognosis. Mortality was associated with Aspergillus coinfection or Pseudomonas aeruginosa,a lower FEV1 and everolimus immunosuppression. There were no functional respiratory sequelae at 1 year in the survivors.

Delbove et al. Pneumocystis pneumonia after lung transplantation: A retrospective multicenter study. Respiratory Medicine, 2020, 106019, ISSN 0954-6111, https://doi.org/10.1016/j.rmed.2020.106019.