Delayed graft function (DGF) in kidney transplantation affects adverse outcomes. It remains unclear whether the post-transplant dialysis modality alters perioperative or long-term graft outcomes. We performed a retrospective observational quality initiative at two Canadian renal transplant centers, in which DGF occurred in the recipient, necessitating one of peritoneal dialysis (PD) or hemodialysis (HD). There was no difference in baseline factors between patients with post-transplant PD (n = 14) or HD (n = 63). The use of PD was associated with an increased risk of wound infection/leakage (PD 5/14 vs. HD 6/63, p = 0.024), shorter length of hospitalization (13.7 vs. 18.7 d, p = 0.009) and time requiring dialysis post-operatively (6.5 vs 11.0 d, p = 0.043). There were no differences in readmission to hospital within 6 months (4/14 vs. 23/63, p = 0.759), graft loss (0/14 vs. 2/63, p = 1.000) or acute rejection episodes (1/14 vs. 4/63, p = 1.000) at one yr, and GFR did not differ between the PD or HD groups at 30 d (35.7 vs. 33.8 mL/min/m(2), p = 0.731), six months (46.9 vs. 45.5 mL/min/m(2), p = 0.835) or one yr (46.6 vs. 44.5 mL/min/m(2), p = 0.746). Further research is needed to determine which transplant patients are most appropriate to undergo PD catheter removal at the time of transplantation.

Our study suggests that increased TND is associated with worse CrCl at 1 year. The data also support the hypothesis of a different mechanism for DGF in DCD and non-DCD kidneys.

Mucorales are environmental fungi, often found in soil and decaying matter. 1,2 Most infections are sporadic-and community-acquired, although there are reported cases of hospital acquisition. Healthcareassociated outbreaks have been linked to adhesive bandages, ostomy bags, wooden tongue depressors, environmental contamination, and invasive medical devices. 3 During a 6-month period, three cases of mucormycosis were identified in recipients of solid organ transplantation. The cases occurred within 3 weeks of the transplant surgery suggesting hospital acquisition. Following this cluster of cases, Infection Prevention and Control (IPC) conducted an outbreak investigation, which included the use of genome sequencing. Herein, we report these cases and demonstrate how genome sequencing can complement traditional IPC outbreak investigations of mucormycosis. Case patients were defined as solid organ transplant recipients from July to December 2017 who had phenotypically identified Rhizomucor species from clinical samples ≥14 days after hospital admission. 3-5 No case patients were discharged from hospital between the time of transplant to diagnosis of mucormycosis. Case-patient 1 is a 70-year-old male who underwent double lung transplantation for idiopathic pulmonary fibrosis. Bronchoscopies post-transplant day (PTD) 1 and 6 were negative for fungal growth. A bronchoalveolar lavage specimen from PTD 11 grew Rhizomucor species in fungal culture. He was started on intravenous liposomal and inhaled amphotericin B on PTD 14. Repeat bronchoscopy samples collected on PTD 26 showed fungal elements but fungal cultures were negative. On PTD 47, treatment was changed to isavuconazole because of kidney injury. His hypoxia improved, and he was repatriated to a community hospital for convalescence and ultimate discharge. Fourteen months after his transplant, he has not had a relapse. Case-patient 2 is a 64-year-old male who underwent double lung transplantation 5 months after case-patient 1 for chronic obstructive pulmonary disease. Following an episode of acute hypoxia, a bronchoscopy was done on PTD 13. Samples collected grew a fungus microscopically identified as Rhizomucor species, although this result was not noted immediately by clinicians. On PTD 33, the patient underwent gastroscopy for an upper gastrointestinal bleed which revealed a gastric ulcer. Biopsies from a repeat gastroscopy showed fungal elements consistent with mucormycosis. Repeat bronchoscopies on PTD 41 and 49 again isolated a fungus microscopically identified as Rhizomucor species. Cranial imaging, to assess altered AbstractWe report three cases of hospital-acquired mucormycosis in heart and lung transplant patients over a 6-month period. Traditional epidemiological investigation tools were used to look for a common link between patients to explain the outbreak.

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