Safety of Once-Weekly Dapsone for Pneumocystis jirovecii Pneumonia Prophylaxis in Kidney Transplant Recipients.

IF 2.6 4区医学 Q3 IMMUNOLOGY

Transplant Infectious Disease Pub Date : 2025-05-01 Epub Date: 2025-02-24 DOI:10.1111/tid.70012

Lauren Schumacher, Olivia Philippart, Abbey Carr, Catherine J Cj Sadler, Sravanthi Paluri

{"title":"Safety of Once-Weekly Dapsone for Pneumocystis jirovecii Pneumonia Prophylaxis in Kidney Transplant Recipients.","authors":"Lauren Schumacher, Olivia Philippart, Abbey Carr, Catherine J Cj Sadler, Sravanthi Paluri","doi":"10.1111/tid.70012","DOIUrl":null,"url":null,"abstract":"Background: Sulfamethoxazole-trimethoprim (SMX-TMP) is recommended first-line for Pneumocystis jirovecii pneumonia (PJP) prophylaxis in kidney transplant recipients. In cases of sulfa allergy or intolerance, our center utilizes dapsone 100 mg once weekly as alternative prophylaxis. As both agents have the potential to cause hematologic abnormalities, we sought to compare hematologic effect profiles of weekly dapsone versus SMX-TMP in kidney transplant recipients.Methods: This retrospective, single-center, cohort study included kidney transplant recipients who received SMX-TMP or dapsone for PJP prophylaxis. The primary endpoint was the change in hemoglobin from baseline to nadir. Secondary endpoints included hemoglobin and white blood cell (WBC) count at 1, 3, and 6 months posttransplant, time to hemoglobin nadir, neutropenia incidence, and ANC nadir. In addition, we evaluated the incidence of hospital readmission, bacteremia, and PJP.Results: A total of 509 kidney transplant recipients were included (334 SMX-TMP vs. 175 dapsone). Median decrease in hemoglobin (g/dL) from baseline to nadir was greater in the dapsone group (0 SMX-TMP vs. -0.20 dapsone; p = 0.046). Mean absolute hemoglobin count was lower in the dapsone group at all time points. There was no difference in WBC, ANC nadir, or incidence of neutropenia at any time point between groups. Greater frequencies in readmissions (30.7% vs. 55.7%; p < 0.001) and bacteremia (3.6% vs. 10.8%; p < 0.001) were observed in the dapsone arm.Conclusions: Once-weekly dapsone is associated with statistically significant decreases in hemoglobin when compared to SMX-TMP in a kidney transplant cohort, which may be clinically relevant in select patients. Dapsone use may also increase infection risk.","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70012"},"PeriodicalIF":2.6000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Transplant Infectious Disease","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/tid.70012","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/24 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"IMMUNOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Sulfamethoxazole-trimethoprim (SMX-TMP) is recommended first-line for Pneumocystis jirovecii pneumonia (PJP) prophylaxis in kidney transplant recipients. In cases of sulfa allergy or intolerance, our center utilizes dapsone 100 mg once weekly as alternative prophylaxis. As both agents have the potential to cause hematologic abnormalities, we sought to compare hematologic effect profiles of weekly dapsone versus SMX-TMP in kidney transplant recipients.

Methods: This retrospective, single-center, cohort study included kidney transplant recipients who received SMX-TMP or dapsone for PJP prophylaxis. The primary endpoint was the change in hemoglobin from baseline to nadir. Secondary endpoints included hemoglobin and white blood cell (WBC) count at 1, 3, and 6 months posttransplant, time to hemoglobin nadir, neutropenia incidence, and ANC nadir. In addition, we evaluated the incidence of hospital readmission, bacteremia, and PJP.

Results: A total of 509 kidney transplant recipients were included (334 SMX-TMP vs. 175 dapsone). Median decrease in hemoglobin (g/dL) from baseline to nadir was greater in the dapsone group (0 SMX-TMP vs. -0.20 dapsone; p = 0.046). Mean absolute hemoglobin count was lower in the dapsone group at all time points. There was no difference in WBC, ANC nadir, or incidence of neutropenia at any time point between groups. Greater frequencies in readmissions (30.7% vs. 55.7%; p < 0.001) and bacteremia (3.6% vs. 10.8%; p < 0.001) were observed in the dapsone arm.

Conclusions: Once-weekly dapsone is associated with statistically significant decreases in hemoglobin when compared to SMX-TMP in a kidney transplant cohort, which may be clinically relevant in select patients. Dapsone use may also increase infection risk.

查看原文本刊更多论文

肾移植受者每周一次使用达哌酮预防肺孢子虫肺炎的安全性

背景：磺胺甲恶唑-甲氧苄啶（SMX-TMP）是肾移植受者预防肺孢子虫肺炎（PJP）的首选药物。对于磺胺过敏或不耐受的病例，我们中心使用每周一次100毫克的氨苯砜作为替代预防药物。由于这两种药物都有可能导致血液学异常，我们试图比较每周一次氨苯砜与SMX-TMP对肾移植受者血液学的影响。方法：这项回顾性、单中心、队列研究纳入了接受SMX-TMP或氨苯砜预防PJP的肾移植受者。主要终点是血红蛋白从基线到最低点的变化。次要终点包括移植后1、3和6个月的血红蛋白和白细胞（WBC）计数、到达血红蛋白最低点的时间、中性粒细胞减少发生率和ANC最低点。此外，我们还评估了再入院、菌血症和PJP的发生率。结果：共纳入509例肾移植受者（334例SMX-TMP vs 175例氨苯砜）。氨苯砜组血红蛋白（g/dL）从基线到最低点的中位下降幅度更大(0 SMX-TMP vs. -0.20氨苯砜；P = 0.046)。氨苯砜组在所有时间点的平均绝对血红蛋白计数均较低。在两组之间的WBC、ANC最低点或中性粒细胞减少发生率在任何时间点均无差异。再入院的频率更高(30.7% vs. 55.7%；结论：在肾移植队列中，与SMX-TMP相比，每周一次氨苯砜与血红蛋白显著降低相关，这可能与特定患者的临床相关。氨苯砜的使用也可能增加感染风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Transplant Infectious Disease 医学-传染病学

CiteScore

5.30

自引率

7.70%

发文量

210

审稿时长

4-8 weeks

期刊介绍： Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal. Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.