Hosseini-Moghaddam Seyed M, Fishman Jay A
Ajmera Transplant Center, Transplant Infectious Diseases Program, University Health Network, University of Toronto, Toronto, ON, Canada.
Division of Infectious Diseases, Department of Medicine, Western University, London, ON, Canada.
JHLT Open. 2025 Aug 7;10:100367. doi: 10.1016/j.jhlto.2025.100367. eCollection 2025 Nov.
pneumonia (PCP) is an opportunistic infectious disease in thoracic solid organ transplant (SOT) recipients, occurring particularly in the setting of augmented immunosuppression. Thoracic allograft recipients are particularly at risk of severe outcomes. Diagnosis is frequently delayed due to nonspecific clinical findings and challenges in ruling out other opportunistic pathogens and distinguishing between pneumonia and colonization. Advances in molecular diagnostics, such as quantitative PCR (qPCR), droplet digital PCR (ddPCR), and loop-mediated isothermal amplification (LAMP), have considerably improved PCP diagnosis. Meanwhile, non-invasive diagnostic applications such as artificial intelligence (AI)-assisted imaging and radiomics hold promise for timely diagnosis. Trimethoprim-sulfamethoxazole (TMP-SMX) remains the first-line therapy; however, shorter treatment durations and lower-dose regimens have not been investigated to reduce toxicity. Alternative agents such as clindamycin-primaquine are used for documented intolerance. The effectiveness of adjunctive glucocorticoid therapy in post-transplant PCP remains unclear. Careful management of immunosuppression following a PCP diagnosis is essential to minimize the risk of allograft rejection. PCP prophylaxis remains a crucial component of the post-transplant preventive strategy, although further research is necessary to determine the optimal duration and dosing regimen. Future efforts should focus on developing risk stratification tools to implement tailored prevention strategies. Interventional studies are needed to provide evidence-based guidelines for PCP management and prevention. Continued advancements in diagnostics, therapeutics, and prophylaxis are vital to reducing the burden of PCP among thoracic SOT recipients.
肺炎（PCP）是胸段实体器官移植（SOT）受者中的一种机会性传染病，尤其在免疫抑制增强的情况下发生。胸段同种异体移植受者特别容易出现严重后果。由于临床症状不具特异性，且在排除其他机会性病原体以及区分肺炎和定植方面存在挑战，诊断常常延迟。分子诊断技术的进步，如定量聚合酶链反应（qPCR）、数字液滴聚合酶链反应（ddPCR）和环介导等温扩增技术（LAMP），显著改善了PCP的诊断。与此同时，人工智能（AI）辅助成像和放射组学等非侵入性诊断应用有望实现及时诊断。甲氧苄啶 - 磺胺甲恶唑（TMP - SMX）仍然是一线治疗药物；然而，尚未对缩短治疗疗程和降低剂量方案以减少毒性进行研究。对于有记录的不耐受情况，可使用克林霉素 - 伯氨喹等替代药物。移植后PCP辅助糖皮质激素治疗的有效性仍不明确。PCP诊断后仔细管理免疫抑制对于将同种异体移植排斥风险降至最低至关重要。PCP预防仍然是移植后预防策略的关键组成部分，尽管需要进一步研究以确定最佳疗程和给药方案。未来的工作应侧重于开发风险分层工具，以实施针对性的预防策略。需要进行干预性研究，为PCP的管理和预防提供循证指南。诊断、治疗和预防方面的持续进步对于减轻胸段SOT受者中PCP的负担至关重要。
