INCIDENCE OF PNEUMOCYSTIS-CARINII PNEUMONIA AFTER RENAL-TRANSPLANTATION - IMPACT OF IMMUNOSUPPRESSION

The incidence and potential risk factors of Pneumocystis carinii pneum onia (PCP) in our population of renal transplant recipients were analy zed retrospectively, Of 1427 patients who received transplants between January 1986 and June 1994, 1192 were evaluated, Four different immun osuppressive regimens were applied: (1) cyclosporine (CsA) + prednisol one (Pred), (2) CsA + azathioprine (Aza, 2 mg/kg/day) + Pred, (3) CsA + Aza + antithymocyte globulin, and (4) (after December 1, 1993, Europ ean multicenter trial) FK506 + Aza (1 mg/kg/day) + Pred, No prophylaxi s against PCP was performed, Before December 1, 1993, three PCPs in 49 4 patients on protocol 2 or 3 occurred (0.6%), Afterward, seven PCPs i n 77 patients occurred (9%): three in 38 patients on protocol 2 (7.8%) and four in 28 patients on protocol 4 (14.3%), Comparing patients wit h PCP on CsA and FK506, the mean Aza dose was 2.40 and 1.32 mg/kg/day, five and two patients received additional steroids, antibody treatmen t was used in three and no patients, and CMV infections occurred in fi ve and two patients, respectively. The incidence of PCP with a moderat e CsA-based immunosuppressive regimen is low and seems to occur only i n cases of additional immunosuppressive cofactors, Despite a general i ncrease of PCP, its incidence was highest in patients on FK506 with fe wer immunosuppressive cofactors, Thus, prophylaxis against PCP after r enal transplantation should be performed, if not in every renal transp lant recipient, at least in case of treatment with additional steroids , antibodies, or FK506.