Pneumocystis jiroveci pneumonia in renal transplantation: time to review our practice?

Pneumocystis jiroveci pneumonia (PJP) is a feared opprtunistic infection in the renal transplant population. The unicellular fungus is ubiquitous in the environment but has an untreated mortality of 90–100% in immunocompromised HIV-negative patients [1]. This falls to 35% with treatment [2]. Many, but not all, transplant centres routinely prescribe PJP prophylaxis. Current European Best Practice Guidelines recommend at least 4 months of PJP prophylaxis post-renal transplantation [3], while KDIGO guidelines suggest 3–6 months [4]. Both guidelines advocate additional prophylaxis during and following the treatment of acute rejection [3, 4].