Scientific Poster Session III - Original Research

Original Research
  Monday, November 13, 2023
  01:00 PM–02:30 PM

Abstract

Introduction: Sulfamethoxazole-trimethoprim (SMZ-TMP) is recommended first-line for pneumocystis jirovecii pneumonia (PJP) prophylaxis in kidney transplant recipients. In cases of sulfa allergy or intolerance, our center utilizes dapsone 100 mg once weekly as alternative prophylaxis. Both agents have the potential to cause hematologic abnormalities.

Research Question or Hypothesis: Compare hematologic adverse effect profiles of weekly dapsone vs SMZ-TMP in kidney transplant recipients.

Study Design: Retrospective, single-center, cohort study.

Methods: Adults who received a kidney transplant between 01/01/2016 and 12/31/2021 and received SMZ-TMP or dapsone for PJP prophylaxis were included. The following were excluded: multi-organ transplant, previous non-renal transplant, HIV positive, or died within six months of transplant. Cohorts were assigned by PJP prophylaxis prescribed at post-operative day (POD) 30. The primary endpoint was the change in hemoglobin from baseline to nadir, where baseline was the hemoglobin value at POD30 and the nadir defined as the lowest hemoglobin value from POD30 to POD180. Secondary endpoints included absolute hemoglobin counts, hemoglobin nadir, and PJP incidence via polymerase chain reaction test.

Results: 521 kidney transplant recipients met inclusion criteria: 342 were assigned to the SMZ-TMP group and 179 to the dapsone group. There was no difference in the median decrease in hemoglobin (g/dL) from baseline to nadir between groups (0 SMZ-TMP vs 0.20 dapsone; p=0.104). The median time between baseline and nadir was also similar between groups (5 days vs 6 days; p=0.753). The mean nadir hemoglobin was lower in the dapsone group (10.88 vs 9.67; p<0.001), however, mean absolute hemoglobin count was lower in the dapsone group at all time points. No cases of PJP were observed.

Conclusion: Hemoglobin trends were similar in kidney transplant recipients receiving SMZ-TMP or weekly dapsone for PJP prophylaxis. Additional adverse effect comparisons are underway.

Presenting Author

Lauren Schumacher PharmD
University of Kentucky

Authors

Abbey Carr PharmD candidate
University of Kentucky

Sravanthi Paluri MD
University of Kentucky

Olivia Roe PharmD
University of Kentucky

Catherine (CJ) Sadler PharmD candidate
University of Kentucky

Aric D. Schadler BS, M.S.
University of Kentucky College of Pharmacy