kidney transplant recipients post transplant pneumonia post transplant infection
As reviewing the literature there is no strong RCT supporting this issue , so is there any clinical experience supporting this?
I do agree! there are not RCT to support the PCP profilaxis beyond 6 mo.
There is no RCTs to support, but as unit practice in SL we are continuing co-trim life long. The plus point is that you don't have to worry about PcP outbreaks. In a pt, who is off co-trim, re-introduction in the wake of a PcP outbreak may raise SCr levels due to blockage of tubular secretion of creatinine by co-trim. This makes most patients anxious and will endup with variety of needless tests. In a country where PcP is extremely prevalent, we continue co-trim life long.
Here is a review article from the American Journal of Transplantation-
http://onlinelibrary.wiley.com/doi/10.1111/ajt.12119/pdf
Duration of prophylaxis for PCP depends on recipient risk factors as well as the prevalence of pneumocystis in your region. The cost of undertaking a RCT may be too high for one to be undertaken, hence one has to rely on what knowledge is available.
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