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World J Transplant. Mar 24, 2016; 6(1): 193-198
Published online Mar 24, 2016. doi: 10.5500/wjt.v6.i1.193
Pentamidine in Pneumocystis jirovecii prophylaxis in heart transplant recipients
Adem Ilkay Diken, Ozlem Erçen Diken, Onur Hanedan, Seyhan Yılmaz, Ata Niyazi Ecevit, Emir Erol, Adnan Yalçınkaya
Adem Ilkay Diken, Seyhan Yılmaz, Emir Erol, Adnan Yalçınkaya, Department of Cardiovascular Surgery, Hitit University Faculty of Medicine, 19100 Corum, Turkey
Ozlem Erçen Diken, Department of Chest Diseases, Hitit University Faculty of Medicine, 19100 Corum, Turkey
Onur Hanedan, Ata Niyazi Ecevit, Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Hospital, 06100 Ankara, Turkey
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: Any author has conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Adem Ilkay Diken, MD, Assistant Professor, Department of Cardiovascular Surgery, Hitit University Faculty of Medicine, Camlik Caddesi No: 2, Bahcelievler Mahallesi, 19100 Corum, Turkey. ademilkay@gmail.com
Telephone: +90-530-6873315
Received: July 22, 2015
Peer-review started: August 6, 2015
First decision: October 13, 2015
Revised: October 21, 2015
Accepted: December 7, 2015
Article in press: December 8, 2015
Published online: March 24, 2016
Processing time: 231 Days and 23.6 Hours
Abstract

Despite advances in transplantation techniques and the quality of post-transplantation care, opportunistic infections remain an important cause of complications. Pneumocystis jirovecii (P. jirovecii) is an opportunistic organism, represents an important cause of infections in heart transplantation patients. Almost 2% to 10% of patients undergoing cardiac transplantation have Pneumocystis pneumonia. Prophylaxis is essential after surgery. Various prophylaxis regimes had been defined in past and have different advantages. Trimethoprim/sulfamethoxazole (TMP/SMX) has a key role in prophylaxis against P. jirovecii. Generally, although TMP/SMX is well tolerated, serious side effects have also been reported during its use. Pentamidine is an alternative prophylaxis agent when TMP/SMX cannot be tolerated by the patient. Structurally, pentamidine is an aromatic diamidine compound with antiprotozoal activity. Since it is not effectively absorbed from the gastrointestinal tract, it is frequently administered via the intravenous route. Pentamidine can alternatively be administered through inhalation at a monthly dose in heart transplant recipients. Although, the efficiency and safety of this drug is well studied in other types of solid organ transplantations, there are only few data about pentamidine usage in heart transplantation. We sought to evaluate evidence-based assessment of the use of pentamidine against P. jirovecii after heart transplantation.

Keywords: Pentamidine; Prophylaxis; Trimethoprim; Heart transplantation; Pneumocystis pneumonia; Pneumocystis jirovecii; Pneumocystis carinii

Core tip: Trimethoprim/sulfomethoxazole (TMP/SMX), the first-line drug for pneumocystis pneumonia prophylaxis following heart transplantation, is well tolerated, however; serious side effects have also been reported during its use. Pentamidine is an alternative prophylaxis agent when TMP/SMX cannot be tolerated following solid organ transplantations. Although there are various studies evaluating the efficiency and safety of pentamidine in these groups, merely reports were found about its usage in heart transplantation recipients. This review aims to evaluate the use of pentamidine against Pneumocystis jirovecii following heart transplantation.