Adjunctive Glucocorticoid Therapy for Pneumocystis jirovecii Pneumonia in Solid Organ Transplant Recipients: A Multicenter Cohort, 2015-2020.

Hosseini-Moghaddam, Seyed M; Kothari, Sagar; Humar, Atul; Albasata, Hanan; Yetmar, Zachary A; Razonable, Raymund R; Neofytos, Dionysios; D'Asaro, Matilde; Boggian, Katia; Hirzel, Cedric; Khanna, Nina; Manuel, Oriol; Mueller, Nicolas J; Imlay, Hannah; Kabbani, Dima; Tyagi, Varalika; Smibert, Olivia C; Nasra, Mohamed; Fontana, Lauren; Obeid, Karam M; ... (2024). Adjunctive Glucocorticoid Therapy for Pneumocystis jirovecii Pneumonia in Solid Organ Transplant Recipients: A Multicenter Cohort, 2015-2020. American journal of transplantation, 24(4), pp. 653-668. Elsevier 10.1016/j.ajt.2023.11.003

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Solid organ transplant recipients (SOTRs) frequently receive adjunctive glucocorticoid therapy (AGT) for Pneumocystis jirovecii pneumonia (PJP). This multicenter cohort of SOTRs with PJP admitted to 20 transplant centers in Canada, the United States, Europe, and Australia, examined whether AGT was associated with a lower rate of all-cause intensive care unit (ICU) admission, 90-day in-hospital death, or a composite outcome (ICU admission or death). Of 172 SOTRs with PJP [median (IQR) age: 60 (51.5-67.0) years, 58 female (33.5%)], the ICU admission and death rates were 43.4%, and 20.8%, respectively. AGT was not associated with a reduced risk of ICU admission [aOR (CI95%): 0.49 (0.21-1.12)], death [aOR (CI95%): 0.80 (0.30-2.17)], or the composite outcome [aOR (CI95%): 10.97 (0.71-1.31)] in the propensity score-adjusted analysis. AGT was not significantly associated with at least 1-unit SOFAResp (the respiratory portion of the Sequential Organ Failure Assessment score) improvement by day 5 [12/37 (32.4%) vs 39/111 (35.1%), p=0.76)]. We did not observe significant associations between AGT and ICU admission or death in SOTRs with PJP. Our findings should prompt a re-evaluation of routine AGT administration in post-transplant PJP treatment and highlight the need for interventional studies.

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