{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T11:37:50Z","timestamp":1787312270200,"version":"build-2736575974"},"reference-count":19,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T00:00:00Z","timestamp":1732665600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transplant Infectious Dis"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Despite limited data supporting use in solid organ transplant (SOT) recipients, atovaquone and dapsone are often used as alternatives to trimethoprim\u2010sulfamethoxazole (TMP\u2010SMX) for\n                      <jats:italic>Pneumocystis jirovecii<\/jats:italic>\n                      pneumonia (PJP) prophylaxis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single\u2010center, retrospective cohort study describes a multi\u2010organ program's experience with alternative PJP prophylaxis. Adult SOT recipients transplanted November 13, 2020 to November 13, 2022 who received non\u2010TMP\u2010SMX PJP prophylaxis and had &gt;\u00a01 year follow\u2010up were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 953 SOTs performed, 333 (34.9%) recipients received alternative PJP prophylaxis (319 [95.8%] atovaquone and 14 [4.2%] dapsone). Alternative prophylaxis was initiated in 76 (22.8%) recipients without starting TMP\u2010SMX, mostly due to sulfa allergy (62, 81.6%). In 257 recipients who started TMP\u2010SMX, common reasons for switching to alternatives were hyperkalemia (105, 40.9%) and leukopenia (77, 30.0%). While 79.8% of recipients had these adverse effects resolve, only 27.3% resumed TMP\u2010SMX. Tolerance was high after resumption (85.7%). Barriers to accessing alternative prophylaxis included cost (25, 7.5%) and prior authorizations (26, 7.8%). There was one case of severe disseminated toxoplasmosis, one case of\n                      <jats:italic>Nocardia<\/jats:italic>\n                      infection, and no cases of PJP.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Alternative PJP prophylaxis carries risk of breakthrough infection and barriers to initiation. Since most recovered from adverse effects of TMP\u2010SMX and tolerated resumption, providers should re\u2010trial TMP\u2010SMX when feasible.\n                      <jats:boxed-text content-type=\"graphic\" position=\"anchor\">\n                        <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/tid14410-gra-0001-m.png\">\n                          <jats:alt-text>image<\/jats:alt-text>\n                        <\/jats:graphic>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/tid.14410","type":"journal-article","created":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T21:49:23Z","timestamp":1732744163000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Alternative Pneumocystis Pneumonia Prophylaxis in Solid Organ Transplants"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2881-5054","authenticated-orcid":false,"given":"Kevin D.","family":"He","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5696-6478","authenticated-orcid":false,"given":"Linh","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Penn Transplant Institute Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4425-1050","authenticated-orcid":false,"given":"Maxwell","family":"Norris","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Penn Transplant Institute Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6321-501X","authenticated-orcid":false,"given":"Gregory","family":"Malat","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Penn Transplant Institute Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0279-2844","authenticated-orcid":false,"given":"Stephanie","family":"Witek","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Penn Transplant Institute Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9071-9662","authenticated-orcid":false,"given":"Chelsea","family":"Sammons","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Penn Transplant Institute Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0975-8139","authenticated-orcid":false,"given":"Abigail","family":"Forte","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Penn Transplant Institute Hospital of the University of Pennsylvania  Philadelphia Pennsylvania 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