Duration of Pneumocystis jirovecii pneumonia prophylaxis in adult kidney transplant recipients and outcomes: A population-based study.

Kidney transplant recipients are prescribed medications to prevent Pneumocystis jirovecii pneumonia (PJP), but there is no consensus regarding the optimal duration of therapy. We used linked health care databases in Alberta, Canada, to describe patterns of PJP prophylactic prescriptions in incident adult kidney transplant recipients (2008-2019) to compare clinical outcomes in recipients taking short-term (≤9 months) versus long-term (>9 months) PJP prophylaxis. We identified 1265 kidney transplant recipients. The median age was 53 years (interquartile range, 41-62 years), 35% were female, and the index estimated glomerular filtration rate was 59 mL/min/1.73 m2 (interquartile range, 47-72 mL/min/1.73 m2). There were 448 (35%) recipients on long-term PJP prophylaxis and 817 (65%) recipients on short-term (median follow-up: 5.7 vs 4.8 years, respectively). There was no significant difference in the risk of all-cause mortality between the groups (11% vs 13%). Recipients in the long-term group were 46% less likely to experience graft failure (4% vs 7%). The risk of hospitalization for PJP infection was low (n = 3, 0.2%), with no significant difference between the groups. Compared to short-term PJP prophylaxis, long-term PJP prophylaxis did not significantly reduce the risk of posttransplant mortality or infection, including PJP infection. Further research is needed to explore the association between PJP prophylaxis and graft survival.