{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T03:51:36Z","timestamp":1791258696331,"version":"4.1.0"},"reference-count":20,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transplant Infectious Dis"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Kidney transplant recipients are at risk for Pneumocystis jirovecii pneumonia (PJP), particularly under profound immunosuppression. Mycophenolic acid (MPA) is widely used after transplantation and is associated with interindividual variability in exposure and hematologic toxicity. Genetic variation affecting MPA metabolism and pharmacodynamics may contribute to lymphopenia and PJP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We performed a matched 1:2 case\u2013control study to assess risk factors for PJP in kidney transplant recipients (1993\u20132022) using multivariable logistic regression. In addition, a retrospective cohort study restricted to PJP cases evaluated recipient polymorphisms in\n                      <jats:italic>UGT1A9<\/jats:italic>\n                      ,\n                      <jats:italic>IMPDH2<\/jats:italic>\n                      , and\n                      <jats:italic>IMPDH1<\/jats:italic>\n                      , and their associations with bone marrow toxicity. P. jirovecii DNA from bronchoalveolar lavage samples was genotyped for IMPDH variants potentially associated with MPA resistance.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Thirty\u2010nine PJP cases and 78 controls were included. Posttransplant cytomegalovirus infection and lymphopenia were independently associated with PJP. Among PJP cases, carriers of the IMPDH1 rs2278294 variant had a significantly higher incidence of lymphopenia, independent of MPA dose. P. jirovecii genotyping was obtained for 24 patients. The\n                      <jats:italic>IMPDH<\/jats:italic>\n                      Ala261Thr variant was detected in 16.7% and the Ala261Ser variant in 22.2% of MPA\u2010treated patients, which is substantially lower than previously reported.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      In kidney transplant recipients with PJP, host genetic variation in IMPDH1, rather than polymorphisms affecting MPA metabolism, appears to be associated with lymphopenia and infection susceptibility. In contrast to prior reports, no clear enrichment of MPA resistance\u2010associated P. jirovecii IMPDH variants was observed. These findings underscore the complexity of host\u2013pathogen interactions under immunosuppressive therapy and highlight the need for larger, well\u2010controlled studies integrating pharmacogenetics and microbial genomics.\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\/tid70257-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.70257","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T05:05:37Z","timestamp":1780549537000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Host and Pathogen Pharmacogenetics in\n                    <i>Pneumocystis jirovecii<\/i>\n                    Pneumonia After Kidney Transplantation: A Retrospective Cohort and Case\u2013Control Study"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9883-1966","authenticated-orcid":false,"given":"Nathalie","family":"Henskens","sequence":"first","affiliation":[{"name":"Department of Nephrology and Renal Transplantation University Hospitals Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8668-1350","authenticated-orcid":false,"given":"Katrien","family":"Lagrou","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Microbiology Department of Microbiology, Immunology and Transplantation KU Leuven  Leuven Belgium"},{"name":"Department of Laboratory Medicine National Reference Center for Mycoses UZ Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4421-6340","authenticated-orcid":false,"given":"Henriette","family":"de Loor","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Immunology and Transplantation Nephrology and Kidney Transplantation Research Group KU Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9433-8752","authenticated-orcid":false,"given":"Lize","family":"Cuypers","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Microbiology Department of Microbiology, Immunology and Transplantation KU Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5546-9680","authenticated-orcid":false,"given":"Dirk","family":"Kuypers","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Renal Transplantation University Hospitals Leuven  Leuven Belgium"},{"name":"Department of Microbiology, Immunology and Transplantation Nephrology and Kidney Transplantation Research Group KU Leuven  Leuven 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