Abstract
BACKGROUND: Pneumocystis jiroveci pneumonia (PJP) prophylaxis is recommended indefinitely for lung transplant recipients (LTR). To mitigate the side effects of oral sulfamethoxazole-trimethoprim (SMX/TMP) in LTR, our center prescribes SMX/TMP single-strength (SS) twice weekly for PJP prophylaxis. To our knowledge, this regimen has not been evaluated in the literature. We sought to determine the incidence of PJP infection and SMX/TMP discontinuation in LTR taking this regimen. METHODS: This retrospective review evaluated LTR first single or bilateral lung transplant at our center from June 1, 2014 to September 1, 2022. Data was obtained from the United Network of Organ Sharing Data Reports and chart review. The primary outcome was the incidence of PJP infection in LTR taking SMX/TMP SS twice weekly at index discharge until 5 years post-lung transplant, graft failure, or last data point, whichever came first. Secondary outcomes assessed SMX/TMP discontinuation, provider rationale for discontinuation, and alternative PJP prophylaxis. RESULTS: A total of 105 patients were included in the analysis. No cases of PJP were seen with SMX/TMP SS twice weekly. SMX/TMP was discontinued in 23 LTR during the study period. By the end of the study period, 43% transitioned back to SMX/TMP SS twice weekly. The overall incidence of indefinite SMX/TMP discontinuation was 12%. Leukopenia was the most common reason for discontinuation. Dapsone was the most common alternative prophylactic agent. CONCLUSION: Our retrospective review of SMX/TMP SS twice weekly for PJP prophylaxis resulted in no PJP infection and may reduce indefinite SMX/TMP discontinuation in LTR.