Invasive Fungal Diseases in Kidney Transplant Recipients: Risk Factors for Mortality

Abstract

Background: Invasive fungal disease (IFD) is common in solid organ transplant (SOT) recipients and contributes to high morbidity and mortality. Although kidney transplantation (KT) is a commonly performed SOT, data on the risk factors for IFD-related mortality are limited. Methods: A 1:2 retrospective case-control study was performed in an experienced single center in the Republic of Korea. We reviewed the electronic medical records of patients with IFD after KT between February 1995 and March 2015. Results: Of 1963 kidney transplant recipients, 48 (2.5%) were diagnosed with IFD. The median interval from KT to IFD diagnosis was 172 days. Invasive aspergillosis (IA) was the most common, followed by invasive candidiasis (IC). Diabetes mellitus (DM) (odds ratio (OR) 3.72, 95% confidence interval (CI) 1.34–10.31, p = 0.011) and acute rejection (OR 3.41, 95% CI 1.41–8.21, p = 0.006) were associated with IFD development. In the subgroup analyses, concomitant bacterial infection was associated with IC development (OR 20.10, 95% CI 3.60–112.08, p = 0.001), and delayed graft function was associated with IA occurrence (OR 10.60, 95% CI 1.05–106.84, p = 0.045). The 12-week mortality rate in all patients was 50.0%. Mortality rates were significantly higher in older patients (adjusted hazard ratio (aHR) 1.06, 95% CI 1.02–1.11, p = 0.004), or those with DM (aHR 2.61, 95% CI 1.02–6.68, p = 0.044), deceased donor transplantation (aHR 2.68, 95% CI 1.03–6.95, p = 0.043), lymphocyte-depleting antibody usage (aHR 0.26, 95% CI 0.08–0.80, p = 0.019), acute rejection (aHR 0.38, 95% CI 0.15–0.97, p = 0.044), and concomitant bacterial infection (aHR 8.76, 95% CI 1.62–47.51, p = 0.012). Conclusions: A total of 50% of IFD cases occurred six months or later after transplantation. The IFD-related mortality rate was high in kidney transplant recipients despite the low incidence. DM and acute rejection were associated with high mortality, as well as IFD development. As old age, deceased donor transplantation, lymphocyte-depleting antibody usage, and concomitant bacterial infection are risk factors for IFD-related mortality, efforts for its early diagnosis and appropriate treatment are required.

Specificities of Meningitis and Meningo-Encephalitis After Kidney Transplantation: A French Retrospective Cohort Study

“…CNS infections caused by filamentous fungi were associated with an early occurrence and a very poor outcome, as already reported ( 9 , 12 , 21 ). All the cases also presented another site of infection that could help with the diagnosis as previously reported ( 21 ).…”

“…A knowledge of the specific epidemiology of central nervous system (CNS) infections in this population is therefore critical to elicit the best probabilistic anti-infectious therapy. Non-etheless, few studies describe the epidemiology, clinical presentation and outcome of M/ME in SOTRs: retrospective cohorts of specific pathogens (12)(13)(14)(15), mixed cohorts of liver, heart, and kidney transplant (KT) recipients (KTRs) (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) and case reports (22)(23)(24)(25)(26)(27).…”

Co-Infección por Cryptococcus neoformans en paciente trasplantado renal con COVID-19. Reporte de caso.

“…Nuestro paciente adicionalmente presentó una coinfección por Cryptococcus en ausencia de infección por HIV, posiblemente por haber recibido manejo inmunosupresor y dexametasona endovenosa en esquema de 7 días [16]. Este hongo es un patógeno oportunista infrecuente en pacientes receptores de órganos sólidos después de los 6 meses de recibido el injerto, y aún más que provoque una infección diseminada sin comprometer sistema nervioso central [18,19]. A su vez, la asociación COVID-19 y Criptococosis es rara, con solo un paciente reportado entre 293 en un estudio de casos realizado en China [20], de ahí la importancia de su difusión, pues sería el primer reporte en la literatura colombiana y latinoamericana de un paciente trasplantado renal con infección por COVID19 y coinfección por Cryptococcus sp.…”

Current Utilization of Antifungal Agents for Intra-abdominal Infections Categorized by Patient Risk Factors During Surgical Procedures: A Literature Review

“…Solid organ transplants (SOT; Table 3) and intra-abdominal surgical procedures (Table 4) have been associated with an increased risk for IC. [32][33][34][35][36][37][38][39][40][41][42][43]…”