Complications Related to Dapsone Use for Pneumocystis Jirovecii Pneumonia Prophylaxis in Solid Organ Transplant Recipients

Authors: Lee, Ingi; Barton, Todd D.¹; Goral, Simin¹; Doyle, Alden M.¹; Bloom, Roy D.¹; Chojnowski, Donna¹; Korenda, Kathleen²; Blumberg, Emily A.¹

Source: American Journal of Transplantation, Volume 5, Number 11, November 2005 , pp. 2791-2795(5)

Publisher: Wiley-Blackwell

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Abstract:

Dapsone, used for prevention of Pneumocystis jirovecii infections, has been reported to cause hemolytic anemia and methemoglobinemia; its tolerability in solid organ transplant recipients is not well described. We investigated dapsone-related adverse events in patients undergoing solid organ transplantation from 1999 to 2004. Transplant providers identified patients for the investigators who then reviewed the patients' hospital and outpatient records. Sixteen solid organ transplant recipients fit case definitions for dapsone-related hemolytic anemia (n = 11) or methemoglobinemia (n = 5). Median time from event to dapsone discontinuation was 15 days; all patients improved after drug discontinuation. G6PD enzyme activity was normal in all patients whose test results were available. Dapsone may be associated with hemolytic anemia or methemoglobinemia, even with normal G6PD levels. These events are often not promptly recognized, and drug discontinuation is delayed. Dapsone-related hemolytic anemia or methemoglobinemia should be considered in solid organ transplant recipients with unexplained anemia or hypoxia.

Keywords: Heart/lung transplantation; heart transplant patients; kidney/liver transplantation; kidney transplantation; liver transplantation; lung transplantation; prophylaxis

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1600-6143.2005.01079.x

Affiliations: 1: Medicine 2: Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

Publication date: 2005-11-01