Pneumocystis jirovecii pneumonia is rare in renal transplant recipients receiving only one month of prophylaxis

Prophylaxis against Pneumocystis jirovecii pneumonia (PCP) is recommended for at least 412months after solid organ transplant. In our center, renal transplant recipients receive only 1month of post-transplant trimethoprimsulfamethoxazole, which also may provide limited protection against Nocardia. We identified only 4 PCP cases and 4 Nocardia cases in 1352 patients receiving renal and renal-pancreas transplant from 2003 to 2009 at the University of Michigan Health System. Two PCP cases were identified <1year after transplant, and 2 PCP cases were identified >1year after transplant (gross attack rate 4/1352, 0.3%). Two Nocardia cases were identified <1year after transplant, and 2 cases were identified >1year after transplant. All identified cases received induction therapy (7 of 8 with anti-thymocyte globulin), whereas about one-half of all renal transplant patients received induction therapy at our institution. No patient was treated for rejection within 6months of PCP; 2 of 4 patients with PCP had recent cytomegalovirus infection. All patients with PCP and 3 of 4 patients with Nocardia survived. The benefits of prolonged PCP prophylaxis should be weighed against the adverse events associated with prolonged use of antimicrobials.