EFFECTIVENESS OF DAILY LOW-DOSE COTRIMOXAZOLE PROPHYLAXIS FOR PNEUMOCYSTIS-CARINII PNEUMONIA IN LIVER-TRANSPLANTATION - AN OPEN CLINICAL-TRIAL

Pneumocystis carinii pneumonia (PCP) is an important infection in the setting of liver transplantation. Without prophylactic measures, the i ncidence of PCP reached 30% in our first 10 liver transplant patients. AU patients but one, who had concomitant invasive aspergillosis, reco vered with intravenous cotrimoxazole. We therefore prospectively studi ed, in an open clinical trial, the efficacy and safety of prophylaxis with daily low-dose cotrimoxazole (480 mg) in 60 patients. The inciden ce of PCP dramatically decreased to 1.7% (P<.01). Treatment was well t olerated, and discontinuation of therapy was only necessary in two pat ients with leukopenia. Nevertheless, the number of episodes of leukope nia was similar in both groups. Cotrimoxazole prophylaxis was not asso ciated with increased nephrotoxicity. An overall benefit in the incide nce of bacterial infection was not observed. We conclude that daily lo w-dose cotrimoxazole is effective and safe for prevention of PCP after liver transplantation.