CLUSTERING OF PNEUMOCYSTIS-CARINII PNEUMONIA IN PATIENTS UNDERGOING RENAL-TRANSPLANTATION FROM LIVING UNRELATED DONORS IN IRAQ AND INDIA

Over the past few years, we have observed a substantial increase in th e number of patients followed at our hospital who have undergone renal transplantation from living unrelated donors (LURD). These transplant s were all performed in one of two centers: Bagdad, Iraq or Bombay, In dia. We have observed a parallel increase in the number of cases of Pn eumocystis carinii pneumonia (PCP) post-renal transplant. We conducted a ten-year retrospective analysis (1986-1995) of patients who develop ed PCP post-renal transplant to determine the risk factors associated with the development of this infection, with particular reference to t he type of transplant and the center in which the transplant was perfo rmed. Over this period, 270 renal transplant patients were followed at this hospital and 10 episodes of PCP were documented (3.7%). Six of t hese cases occurred within the last 2 years, as compared to only 4 cas es in the preceding 8 years. All of the cases observed in the last 2 y ears occurred in patients who had undergone renal transplantation from LURD in Iraq or in India. During the same period, we observed no case s of PCP in patients who had undergone transplantation in Israel (cada ver or related living donor transplants). We could find no difference between patients undergoing transplant from LURD and those undergoing other transplants in terms of immune-suppressive therapy, frequency of organ rejection episodes or coexistent CMV infection. All patients we re of Arab descent and live in the West Bank. Although we cannot ident ify any obvious explanation for this association, we believe that thes e cases represent a true cluster phenomenon. We therefore feel it is w arranted for all recipients of renal transplants from living unrelated donors seen in our hospital to receive prophylactic therapy for Pneum ocystis carinii pneumonia.