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Background <p>Immunosuppressants are essential for post-transplant maintenance therapy. <i>Pneumocystis jirovecii</i> is an opportunistic fungal pathogen that can cause severe pneumonia (PCP) in immunocompromised individuals. The aim of our study is to determine the association between different immunosuppressant regimens and the risk of PCP in kidney transplant recipients.</p> Methods <p>The data were collected from the PubMed, Cochrane Library, and Web of Science databases. A total of eleven studies met the inclusion and exclusion criteria and were included in the meta-analysis. Key information was collected from each study, and the primary outcome was the incidence of PCP under the different immunosuppressive therapy regimens. Odds ratios (OR) with 95% confidence intervals (95%CI) were used to analyze the outcomes. All results are analysed at a significance level of 0.05.</p> Results <p>The outcomes showed kidney transplant recipients received azathioprine (AZA) had the higher risk of PCP (OR = 1.62, 95%CI 1.02–2.59, <i>P</i> = 0.04), and the risk of PCP was lower in patients receiving mycophenolate mofetil (MMF) therapy than those received AZA therapy (OR = 0.60, 95%C = 0.37–0.97, <i>P</i> = 0.04). The incidence of PCP was no significant difference between TAC and CYA regimens (OR = 0.86, 95%CI 0.69–1.07, <i>P</i> = 0.17). No significant association between MMF (OR = 1.00, 95%C = 0.61–1.63, <i>P</i> = 1.00) or sirolimus (OR = 1.78, 95%C = 0.37–8.42, <i>P</i> = 0.47) and the risk of PCP.</p> Conclusion <p>Receiving AZA was the risk factor of PCP infection in kidney transplant recipients, and has a higher risk of PCP infection compared to patients receiving MMF. These findings provide new insights for identifying high-risk populations and developing targeted prophylactic strategies against PCP in clinical practice.</p>

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Impact of different immunosuppressants on the incidence of Pneumocystis jirovecii pneumonia in kidney transplant recipients: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2025年8月4日

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  • Huyu Wang,
  • Jing Guo,
  • Chengjun Yu,
  • Jie Zhang,
  • Hanyu Xiao,
  • Sheng Wen,
  • Yajuan Chen,
  • Yi Hua

摘要

Background

Immunosuppressants are essential for post-transplant maintenance therapy. Pneumocystis jirovecii is an opportunistic fungal pathogen that can cause severe pneumonia (PCP) in immunocompromised individuals. The aim of our study is to determine the association between different immunosuppressant regimens and the risk of PCP in kidney transplant recipients.

Methods

The data were collected from the PubMed, Cochrane Library, and Web of Science databases. A total of eleven studies met the inclusion and exclusion criteria and were included in the meta-analysis. Key information was collected from each study, and the primary outcome was the incidence of PCP under the different immunosuppressive therapy regimens. Odds ratios (OR) with 95% confidence intervals (95%CI) were used to analyze the outcomes. All results are analysed at a significance level of 0.05.

Results

The outcomes showed kidney transplant recipients received azathioprine (AZA) had the higher risk of PCP (OR = 1.62, 95%CI 1.02–2.59, P = 0.04), and the risk of PCP was lower in patients receiving mycophenolate mofetil (MMF) therapy than those received AZA therapy (OR = 0.60, 95%C = 0.37–0.97, P = 0.04). The incidence of PCP was no significant difference between TAC and CYA regimens (OR = 0.86, 95%CI 0.69–1.07, P = 0.17). No significant association between MMF (OR = 1.00, 95%C = 0.61–1.63, P = 1.00) or sirolimus (OR = 1.78, 95%C = 0.37–8.42, P = 0.47) and the risk of PCP.

Conclusion

Receiving AZA was the risk factor of PCP infection in kidney transplant recipients, and has a higher risk of PCP infection compared to patients receiving MMF. These findings provide new insights for identifying high-risk populations and developing targeted prophylactic strategies against PCP in clinical practice.