{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T17:10:14Z","timestamp":1781197814524,"version":"3.54.1"},"reference-count":35,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,11,29]],"date-time":"2020-11-29T00:00:00Z","timestamp":1606608000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100005622","name":"Health Research","doi-asserted-by":"publisher","award":["340137"],"award-info":[{"award-number":["340137"]}],"id":[{"id":"10.13039\/100005622","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transplant Infectious Dis"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p><jats:italic>Pneumocystis jirovecii<\/jats:italic> pneumonia (PJP) is a significant cause of morbidity and mortality in transplant patients yet little is known about their adherence to prophylaxis. The goal of this study was to evaluate patient uptake and long\u2010term adherence after implementing universal, lifelong PJP prophylaxis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>This retrospective cohort study evaluated an adult kidney transplant program 18\u2010months after initiating trimethoprim\u2010sulfamethoxazole (TMP\u2010SMX) 80\/400\u00a0mg thrice\u2010weekly following a cluster of PJP cases. The protocol incorporated multi\u2010modal patient education and drug tolerability strategies to improve adherence, including a modified re\u2010challenge strategy for TMP\u2010SMX intolerance. Adherence was independently confirmed by the transplant pharmacist and nurse for each patient, with an a priori target \u2265\u00a075% population on prophylaxis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Initial uptake was high with 237\/250 (94.8%) patients starting prophylaxis. Long\u2010term maintenance was high with 192\/237 (81.0%) patients remaining on prophylaxis at 18\u2010months. Of the remaining 45 patients who initiated prophylaxis, 36\/237 (15.2%) were non\u2010adherent and 9\/237 (3.8%) discontinued prophylaxis by 18\u2010months. Reasons for non\u2010adherence included gastrointestinal upset, fear of drug reactions and cost; but the majority of reasons were not delineated by the patients (31\/36, 86.1%). There was a statistically significant increase in serum creatinine 3.3\u00a0\u00b5mol\/L (0.3\u20106.3\u00a0\u00b5mol\/L 95% CI) and potassium 0.08\u00a0mmol\/L (0.03\u20100.15\u00a0mmol\/L 95% CI) in those prescribed TMP\u2010SMX with only 3\/237 (1.3%) patients discontinuing TMP\u2010SMX for an increase in creatinine.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>High rates of patient uptake (94.8%) and long\u2010term adherence (81.0%) were observed after implementing universal lifelong PJP prophylaxis. This may be due in part to the in\u2010depth patient education and drug tolerability strategies employed.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tid.13509","type":"journal-article","created":{"date-parts":[[2020,11,10]],"date-time":"2020-11-10T22:50:58Z","timestamp":1605048658000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Lifelong, universal <i>Pneumocystis jirovecii<\/i> pneumonia prophylaxis: Patient uptake and adherence after kidney transplant"],"prefix":"10.1111","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8234-1823","authenticated-orcid":false,"given":"Kathryn","family":"Peterson","sequence":"first","affiliation":[{"name":"Winnipeg Regional Health Authority Winnipeg MB Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liam","family":"Berrigan","sequence":"additional","affiliation":[{"name":"Winnipeg Regional Health Authority Winnipeg MB Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarina","family":"Popovic","sequence":"additional","affiliation":[{"name":"Winnipeg Regional Health Authority Winnipeg MB Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Wiebe","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Manitoba Winnipeg MB Canada"},{"name":"Department of Immunology University of Manitoba Winnipeg MB Canada"},{"name":"Shared Health Services Manitoba Winnipeg MB Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siyao","family":"Sun","sequence":"additional","affiliation":[{"name":"Winnipeg Regional Health Authority Winnipeg MB Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8342-9093","authenticated-orcid":false,"given":"Julie","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Manitoba Winnipeg MB Canada"},{"name":"Department of Immunology University of Manitoba Winnipeg MB Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,11,29]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1086\/523814"},{"issue":"3","key":"e_1_2_8_3_1","first-page":"298","article-title":"Pneumocystis jirovecii colonization in non\u2010HIV\u2010infected patients based on nested\u2010PCR detection in bronchoalveolar lavage samples","volume":"42","author":"Khodadadi H","year":"2013","journal-title":"Iranian J Public Health"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-019-1407-x"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/tid.12651"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e3181aad256"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2013.212"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/1529-0131(200008)43:8<1841::AID-ANR21>3.0.CO;2-Q"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD005590.pub3"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2009.377"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2010.05.004"},{"issue":"5","key":"e_1_2_8_12_1","article-title":"Risk factors for Pneumocystis pneumonia after the first 6 months following renal transplantation","volume":"19","author":"Faure E","year":"2017","journal-title":"Transplant Infect"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2019.02.013"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/tid.12984"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e3182a1618c"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1086\/653933"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1086\/513198"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2014.07.010"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3062.2009.00447.x"},{"issue":"1","key":"e_1_2_8_20_1","first-page":"81","article-title":"Management of Pneumocystis jirovecii pneumonia in kidney transplantation to prevent further outbreak. Clinical medicine insights","volume":"9","author":"Goto N","year":"2015","journal-title":"Circul Respir Pulm Med"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/TXD.0000000000000665"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir996"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2015.11.012"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-019-3944-0"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis217"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e3181aed389"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(90)90337-D"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1086\/313509"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1083-8791(00)70050-4"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.34.7.1754-1759.1996"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.14498"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.7182\/pit2015153"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11096-017-0436-4"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000000148"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-0012.2009.01129.x"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/nep.12201"}],"container-title":["Transplant Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tid.13509","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/tid.13509","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tid.13509","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,30]],"date-time":"2023-08-30T18:00:20Z","timestamp":1693418420000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/tid.13509"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,29]]},"references-count":35,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2021,6]]}},"alternative-id":["10.1111\/tid.13509"],"URL":"https:\/\/doi.org\/10.1111\/tid.13509","archive":["Portico"],"relation":{},"ISSN":["1398-2273","1399-3062"],"issn-type":[{"value":"1398-2273","type":"print"},{"value":"1399-3062","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,29]]},"assertion":[{"value":"2020-07-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-10-11","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-11-29","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e13509"}}