Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Liver Transplantation Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Eur J Clin Pharmacol. 2019 Nov;75(11):1471-1480. doi: 10.1007/s00228-019-02730-0. Epub 2019 Aug 3.
Although there is controversy, some evidences proposed increased risk of post-transplant Pneumocystis carinii pneumonia (PCP) in patients receiving mammalian target of rapamycin (mTOR) inhibitors. This study aimed to examine the association between m-TOR inhibitors and the risk of developing PCP in solid organ transplant (SOT) recipients.
A comprehensive search was performed to find the eligible studies that investigated the incidence of PCP in patients treated with mTOR inhibitors after SOT. Random effect model was applied for meta-analysis.
Combination of 15 effect sizes showed a significant positive association between mTOR inhibitor administration and the risk of PCP (OR = 1.90, 95%CIs = 1.44, 2.75). There was no heterogeneity between studies (I = 3.5%). Subgroup analysis revealed increased risk of PCP after the first year of transplantation (P < 0.001).
In conclusion, administration of mTOR inhibitors is a potential risk factor for late-onset PCP after SOT. Targeted PCP prophylaxis based on recipients' risk factors rather universal prophylaxis may lessen the risk.
尽管存在争议，但一些证据表明，接受雷帕霉素靶蛋白（mTOR）抑制剂治疗的患者发生移植后卡氏肺孢子虫肺炎（PCP）的风险增加。本研究旨在探讨 mTOR 抑制剂与实体器官移植（SOT）受者发生 PCP 的风险之间的关系。
进行了全面检索，以寻找调查 SOT 后接受 mTOR 抑制剂治疗的患者发生 PCP 发生率的合格研究。应用随机效应模型进行荟萃分析。
15 项效应量的组合表明，mTOR 抑制剂的使用与 PCP 的风险之间存在显著的正相关（OR=1.90，95%CI=1.44，2.75）。研究之间没有异质性（I=3.5%）。亚组分析显示，移植后第一年发生 PCP 的风险增加（P<0.001）。
总之，mTOR 抑制剂的使用是 SOT 后迟发性 PCP 的潜在危险因素。基于受者危险因素的靶向 PCP 预防而非普遍预防可能会降低风险。
