ArticleTransplant infectious disease : an official journal of the Transplantation Society
Alternative Pneumocystis Pneumonia Prophylaxis in Solid Organ Transplants.
Article in Transplant infectious disease : an official journal of the Transplantation Society. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Prophylaxis Regimens forJournal of fungi (Basel, Switzerland) · 2026Review
- Advances in the postoperative care of the liver transplant recipient.Current opinion in critical care · 2026Review
- Article
- A nomogram-based clinical prediction model for adverse clinical outcomes in non-HIV Pneumocystis jirovecii pneumonia patients.BMC pulmonary medicine · 2025Article
- Optimizing Pneumocystis jirovecii Prophylaxis in Immunocompromised Patients: Defining the Clinical Role of Atovaquone.Transplant infectious disease : an official journal of the Transplantation SocietyArticle
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDespite limited data supporting use in solid organ transplant (SOT) recipients, atovaquone and dapsone are often used as alternatives to trimethoprim-sulfamethoxazole (TMP-SMX) for Pneumocystis jirovecii pneumonia (PJP) prophylaxis.
methodsThis single-center, retrospective cohort study describes a multi-organ program's experience with alternative PJP prophylaxis. Adult SOT recipients transplanted November 13, 2020 to November 13, 2022 who received non-TMP-SMX PJP prophylaxis and had > 1 year follow-up were included.
resultsAmong 953 SOTs performed, 333 (34.9%) recipients received alternative PJP prophylaxis (319 [95.8%] atovaquone and 14 [4.2%] dapsone). Alternative prophylaxis was initiated in 76 (22.8%) recipients without starting TMP-SMX, mostly due to sulfa allergy (62, 81.6%). In 257 recipients who started TMP-SMX, common reasons for switching to alternatives were hyperkalemia (105, 40.9%) and leukopenia (77, 30.0%). While 79.8% of recipients had these adverse effects resolve, only 27.3% resumed TMP-SMX. Tolerance was high after resumption (85.7%). Barriers to accessing alternative prophylaxis included cost (25, 7.5%) and prior authorizations (26, 7.8%). There was one case of severe disseminated toxoplasmosis, one case of Nocardia infection, and no cases of PJP.
conclusionAlternative PJP prophylaxis carries risk of breakthrough infection and barriers to initiation. Since most recovered from adverse effects of TMP-SMX and tolerated resumption, providers should re-trial TMP-SMX when feasible.
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