PNEUMOCYSTIS-CARINII PNEUMONIA AFTER LIVER-TRANSPLANTATION IN ADULTS

Proven Pneumocystis carinii pneumonia (PCP) occurred in 8 (5.2%) of 15 4 adult liver transplant recipients between January 1986 and December 1992. The interval between transplantation and PCP ranged from 69 to 1 31 days with a mean of 95 days (SD 20 days). The PaO2 breathing room a ir at diagnosis ranged from 40 mmHg to 75 mmHg with a mean of 59.6 mmh g (SD 13 mmHg). Bronchial washings taken at bronchoscopy stained posit ively for Pneumocystis carinii and confirmed the diagnosis. Transbronc hial biopsy was unnecessary for diagnosis. One patient died from PCP w hile the remainder recovered. Patients transplanted immediately before the index patients served as controls. Patients who developed PCP had more episodes of rejection (p < 0.05), received more OKT3 (p < 0.05), and were receiving more prednisone (p < 0.05) than controls. They als o had lower levels of albumin (p < 0.01), and higher levels of alkalin e phosphatase (p < 0.05), alanine(p < 0.01), and aspartate aminotransf erase (p < 0.001), and gamma-glutamyltranspeptidase (p < 0.02). This s tudy raises the possibility of selecting patients at risk of PCP for c hemoprophylaxis.