Liver transplantation without pneumocytsis jirovecii prophylaxis - Single center experience.

Background and Aim: Pneumocystis jirovecii (PJ) can be seen in solid organ transplant (SOT) recipients. Despite guidelines recommending PJP prophylaxis for 6-12 months post-transplantation, the necessity for liver transplant patients remains controversial, with conflicting evidence on PJP rates. This study examined PJP occurrence in 242 liver transplant patients at a single center who received no PJP prophylaxis. Materials and Methods: A retrospective study examined the clinical and microbiological data of 242 liver transplant (LTx) patients to evaluate PJP incidence within one year post-transplant. PJP was diagnosed microbiologically and/or radiologically in cases of clinical suspicion, without systematic screening. The study investigated PJP infection risk factors reported previously, including cytomegalovirus (CMV) infection, bolus steroid therapy, age >65, prolonged neutropenia, and anti-thymocyte globulin (ATG) usage. Results: The study involved 242 liver transplant recipients, with an average age of 56 years, predominantly male (71%), and a mean Model for End-Stage Liver Disease (MELD) score of 16. No PJP cases were reported. Among PJP risk factors, none had prolonged neutropenia, though two developed CMV infection. Empirical steroid bolus treatment for suspected acute cellular rejection was given to 62 patients (26%). The cohort included 22 (9%) individuals over 65 years old, and none received ATG. Conclusion: This pioneering study examines a substantial living liver donor transplantation (LDLT) cohort without PJP prophylaxis, suggesting it may be unnecessary in centers with low immunosuppression and a low percentage of risk factors. Prospective studies are essential to establish targeted prophylactic approaches due to variations in PJP incidence across centers.