Epidemiology and outcome of invasive fungal infections in solid organ transplant recipients

Abstract

Contemporary epidemiology and outcomes of invasive fungal infections (IFIs) in solid organ transplant (SOT) recipients are not well described. From March 2004 through September 2007, proven and probable IFIs were prospectively identified in 17 transplant centers in the United States. A total 429 adult SOT recipients with 515 IFIs were identified; 362 patients received a single and 67 patients received >or=2 organs. Most IFIs were caused by Candida species (59.0%), followed by Aspergillus species (24.8%), Cryptococcus species (7.0%), and other molds (5.8%). Invasive candidiasis (IC) was the most frequently observed IFI in all groups, except for lung recipients where invasive aspergillosis (IA) was the most common IFI (P<0.0001). Almost half of IC cases in liver, heart, and lung transplant recipients occurred during the first 100 days post transplant. Over half of IA cases in lung recipients occurred >1 year post transplant. Overall 12-week mortality was 29.6%; liver recipients had the highest mortality (P=0.05). Organ damage, neutropenia, and administration of corticosteroids were predictors of death. These results extend our knowledge on the epidemiology of IFI in SOT recipients, emphasizing the occurrence of IC early after non-lung transplant, and late complications with molds after lung transplant. Overall survival appears to have improved compared with historical reports.

Epidemiology of fungal infections in liver transplant recipients: a six-year study of a large Brazilian liver transplantation centre

“…Recently, Pappas et al (2010) observed a 12-month survival of 59% in a surveillance study performed in solid organ transplant recipients. In a similar study, Neofytos et al (2010) reported a three-month survival of 70% in a mixed population of organ recipients, but lower rates were observed in liver recipients, probably as result of the acuity of systemic illness and the patients' underlying compromised status.…”

“…Mortality rates after an invasive fungal episode ranged from 50-92% in previous reports (Neofytos et al 2010). Recently, Pappas et al (2010) observed a 12-month survival of 59% in a surveillance study performed in solid organ transplant recipients.…”

“…Other fungal species such as Cryptococcus neoformans, the non-Aspergillus filamentous species and the endemic mycosis agents such as histoplasmosis, coccidioidomycosis and blastomycosis have variable incidences, depending on the geographic origin of the patient (Singh 2000, Fung 2002, Cruciani et al 2006, Playford et al 2006). In two recent multicentre studies, the incidence of invasive candidiasis ranged from 68-78.7%, while the incidence of invasive aspergillosis and cryptococcosis varied from 7.9-11% and from 6-7.1%, respectively (Neofytos et al 2010, Pappas et al 2010.…”

Caspofungin versus fluconazole as prophylaxis of invasive fungal infection in high‐risk liver transplantation recipients: A propensity score analysis

“…(1)(2)(3)(4)(5) Although most IFIs are due to Candida spp., the risk and severity of invasive aspergillosis (IA) in LTRs is well known. (6,7) Universal prophylaxis, mainly with fluconazole, is controversial in patients with a low risk of IFIs.…”

Complications of Post-Transplant Immunosuppression

“…Fungal infections post-transplant cause significant morbidity and increase the mortality risk (review in [34]). Candida spp.…”