European Journal of Clinical Pharmacology

, Volume 75, Issue 11, pp 1471–1480 | Cite as

m-TOR inhibitors and risk of Pneumocystis pneumonia after solid organ transplantation: a systematic review and meta-analysis

  • Maryam Ghadimi
  • Zinat Mohammadpour
  • Simin Dashti-KhavidakiEmail author
  • Alireza Milajerdi



Although there is controversy, some evidences proposed increased risk of post-transplant Pneumocystis carinii pneumonia (PCP) in patients receiving mammalian target of rapamycin (mTOR) inhibitors. This study aimed to examine the association between m-TOR inhibitors and the risk of developing PCP in solid organ transplant (SOT) recipients.


A comprehensive search was performed to find the eligible studies that investigated the incidence of PCP in patients treated with mTOR inhibitors after SOT. Random effect model was applied for meta-analysis.


Combination of 15 effect sizes showed a significant positive association between mTOR inhibitor administration and the risk of PCP (OR = 1.90, 95%CIs = 1.44, 2.75). There was no heterogeneity between studies (I2 = 3.5%). Subgroup analysis revealed increased risk of PCP after the first year of transplantation (P < 0.001).


In conclusion, administration of mTOR inhibitors is a potential risk factor for late-onset PCP after SOT. Targeted PCP prophylaxis based on recipients’ risk factors rather universal prophylaxis may lessen the risk.


mTOR inhibitors Pneumocystis pneumonia Solid organ transplant Sirolimus Everolimus Meta-analysis 


Authors’ contribution

Maryam Ghadimi and Zinat Mohammadpour participated in doing literature review, data extraction from included articles, assessment of the quality of included articles, data analysis, and manuscript drafting. Simin Dashti-Khavidali provided the idea of this systematic review, participated in doing literature review, data extraction from included articles, critical evaluation of the manuscript, and finalizing the manuscript. Alireza Milajerdi participated in data analysis and manuscript drafting.


There is no funding support for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Maryam Ghadimi
    • 1
  • Zinat Mohammadpour
    • 2
  • Simin Dashti-Khavidaki
    • 2
    • 3
    Email author
  • Alireza Milajerdi
    • 4
  1. 1.Department of Clinical Pharmacy, Faculty of PharmacyTehran University of Medical SciencesTehranIran
  2. 2.Liver Transplantation Research Center, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
  3. 3.Faculty of PharmacyTehran University of Medical SciencesTehranIran
  4. 4.Department of Community Nutrition, School of Nutritional Sciences and DieteticsTehran University of Medical SciencesTehranIran

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