Adjunctive glucocorticoid therapy for Pneumocystis jirovecii pneumonia in solid organ transplant recipients: A multicenter cohort, 2015-2020

Seyed M. Hosseini-Moghaddam, Sagar Kothari, Atul Humar, Hanan Albasata, Zachary A. Yetmar, Raymund R. Razonable, Dionysios Neofytos, Matilde D'Asaro, Katia Boggian, Cedric Hirzel, Nina Khanna, Oriol Manuel, Nicolas J. Mueller, Hannah Imlay, Dima Kabbani, Varalika Tyagi, Olivia C. Smibert, Mohamed Nasra, Lauren Fontana, Karam M. ObeidAnna Apostolopoulou, Sean X. Zhang, Nitipong Permpalung, Hind Alhatimi, Michael S. Silverman, Henry Guo, Benjamin A. Rogers, Erica MacKenzie, Jennifer Pisano, Francesca Gioia, Lindita Rapi, G. V.Ramesh Prasad, Marcela Banegas, Carolyn D. Alonso, Kathleen Doss, Robert M. Rakita, Jay A. Fishman

Research output: Contribution to journalArticlepeer-review


Solid organ transplant recipients (SOTRs) frequently receive adjunctive glucocorticoid therapy (AGT) for Pneumocystis jirovecii pneumonia (PJP). This multicenter cohort of SOTRs with PJP admitted to 20 transplant centers in Canada, the United States, Europe, and Australia, was examined for whether AGT was associated with a lower rate of all-cause intensive care unit (ICU) admission, 90-day death, or a composite outcome (ICU admission or death). Of 172 SOTRs with PJP (median [IQR] age: 60 (51.5-67.0) years; 58 female [33.7%]), the ICU admission and death rates were 43.4%, and 20.8%, respectively. AGT was not associated with a reduced risk of ICU admission (adjusted odds ratio [aOR] [95% CI]: 0.49 [0.21-1.12]), death (aOR [95% CI]: 0.80 [0.30-2.17]), or the composite outcome (aOR [95% CI]: 0.97 [0.71-1.31]) in the propensity score-adjusted analysis. AGT was not significantly associated with at least 1 unit of the respiratory portion of the Sequential Organ Failure Assessment score improvement by day 5 (12/37 [32.4%] vs 39/111 [35.1%]; P = .78). We did not observe significant associations between AGT and ICU admission or death in SOTRs with PJP. Our findings should prompt a reevaluation of routine AGT administration in posttransplant PJP treatment and highlight the need for interventional studies.

Original languageEnglish (US)
Pages (from-to)653-668
Number of pages16
JournalAmerican Journal of Transplantation
Issue number4
StatePublished - Apr 2024


  • Pneumocystis jirovecii
  • Pneumocystis pneumonia
  • solid organ transplantation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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