*PURPOSE: Kidney transplant recipients are at increased risk for _Pneumocystis jirovecii_ pneumonia (PJP). PJP prophylaxis is commonly used for 6 to 12 months after transplant, thus shifting the incidence of infection to subsequent years. We aimed to determine risk factors for posttransplant PJP by using nationwide data. *METHODS: Using the United States Renal Data System (USRDS) database, we performed a retrospective case-control study of patients who underwent kidney transplant from 1998 through 2019. To evaluate risk factors for PJP, we performed a conditional logistic regression analysis by comparing characteristics between PJP-infected patients and their matched uninfected controls. *RESULTS: We matched 407 patients with PJP to 1624 uninfected controls (1:4)(Table 1). PJP was diagnosed at a median of 54.3 months after kidney transplant, with 3.2% of the cases occurring within 6 months of transplant and 14.7% within the first year. Patients in the PJP group, had a mean age at transplant of 52.5 years and the most common transplant indication was diabetic nephropathy. The mean time on dialysis before transplant was 2.77 years. Eighty-patients (19.7%) had a history of pulmonary disease, 117 (28.7%) had a history of CMV infection after transplant and 182 (44.7%) had a history of acute rejection. In multivariate analysis risk factors for PJP were Asian race, history of polycystic kidney disease, longer duration of pre-transplant hemodialysis, higher Elixhauser comorbidity index, older donor age, history of prior transplant, and history of CMV infection. Protective factors included having a living donor(Table 2). *CONCLUSIONS: Multiple risk factors were associated to developing PJP after kidney transplant. We found that older donor age was associated with increased risk, whereas receiving transplant from a living donor was protective. Longer duration of pre-transplant hemodialysis also increased the risk of PJP. This may be explained by the effect of persistent uremia on cell mediated immunity and/or the longer exposure to the healthcare system. Our findings emphasize the importance of timely transplantation to decrease the risk of PJP. [

] [

]CITATION INFORMATION: Mendoza M., Friedman D., Johnson B., Vergidis P. Risk Factors for Pneumocystis Jirovecii Pneumonia in Renal Transplant Recipients: A Case-Control Study from the USRDS Database AJT, Volume 23, Issue 6, Supplement 1.

Maria Mendoza MD

Mayo Clinic

Appearances