PNEUMOCYSTIS JIROVECII PNEUMONIA IN TRANSPLANT RECIPIENTS: TIME-DEPENDENT RISK AND CLINICAL IMPLICATIONS – A LITERATURE REVIEW

Karolina Baran; Aleksandra Serafin; Maja Podolak; Aleksandra Suchołbiak; Oskar Mikołajczyk; Klaudia Pachulska; Irmina Grygutis; Urszula Jarzęcka

doi:10.31435/ijitss.2(50).2026.6073

Authors

Karolina Baran John Paul II Western Hospital in Grodzisk Mazowiecki, Daleka 11, 05-825 Grodzisk Mazowiecki, Poland https://orcid.org/0009-0006-3076-2892
Aleksandra Serafin Czerniakowski Hospital Sp. z o.o., Stępińska 19/25, 00-739 Warsaw, Poland https://orcid.org/0009-0002-2573-0811
Maja Podolak Mazovian Bródnowski Hospital Sp. z o.o., ul. Kondratowicza 8, 03-242 Warsaw, Poland https://orcid.org/0009-0005-5409-8511
Aleksandra Suchołbiak Infant Jesus Clinical Hospital, Williama Heerleina Lindleya 4, 02-005 Warsaw, Poland https://orcid.org/0009-0001-2931-157X
Oskar Mikołajczyk Infant Jesus Clinical Hospital, Williama Heerleina Lindleya 4, 02-005 Warsaw, Poland https://orcid.org/0009-0006-8470-6845
Klaudia Pachulska Medical University of Warsaw, ul. Żwirki i Wigury 61, 02-091 Warsaw, Poland https://orcid.org/0009-0003-5105-8798
Irmina Grygutis Nicolaus Copernicus Hospital in Gdańsk, Gdańsk, Poland https://orcid.org/0009-0008-2863-3471
Urszula Jarzęcka Medical Centre for Postgraduate Education, Professor W. Orlowski Memorial Hospital, Czerniakowska 231, 00-416 Warsaw, Poland https://orcid.org/0009-0009-1160-8541

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.6073

Keywords:

Pneumocystis Jirovecii Pneumonia, Solid Organ Transplantation, Opportunistic Infections, Immunosuppression, Prophylaxis

Abstract

Pneumocystis jirovecii pneumonia (PJP) remains a clinically significant opportunistic infection in solid organ transplant (SOT) recipients despite advances in prophylaxis, diagnostics, and treatment. This review aims to summarize current knowledge regarding epidemiology, risk factors, diagnosis, treatment, and prevention of PJP in this population, with particular emphasis on evolving concepts of risk stratification. Although universal trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis has significantly reduced incidence, breakthrough and late-onset infections continue to occur, particularly in the context of fluctuating immunosuppression. The risk of PJP is primarily determined by the net state of immunosuppression rather than time since transplantation alone. Key risk factors include lymphopenia, cytomegalovirus infection or reactivation, treatment of acute rejection with high-dose corticosteroids or lymphocyte-depleting agents, hypogammaglobulinemia, and advanced age. Clinically, PJP in SOT recipients is often acute and rapidly progressive, frequently leading to severe hypoxemic respiratory failure and higher mortality compared with HIV-associated disease. Diagnosis requires integration of clinical findings, high-resolution computed tomography, and microbiological analysis of bronchoalveolar lavage. Molecular assays improve sensitivity, but differentiation between active infection and colonization remains challenging. Serum (1→3)-β-D-glucan may support diagnosis but lacks specificity. Trimethoprim-sulfamethoxazole remains first-line therapy and prophylaxis, while alternative agents are less effective. Emerging molecular and immunological tools may improve risk stratification and guide individualized prophylaxis strategies.

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