Risk factors for intra‐abdominal fungal infection after simultaneous pancreas‐kidney transplantation: A single‐center retrospective experience

Abstract

Background Data on the risk factors and outcome of intra‐abdominal fungal infections (IAFI) following simultaneous pancreas‐kidney transplantation (PKT) are scarce. Materials/methods A retrospective monocentric study was conducted on all patients who underwent simultaneous PKT from January 2007 to December 2016. Deep sites positive cultures for fungi during the first post‐transplantation year were collected. Clinical, radiological, and microbiological data of proven and probable invasive fungal infections were analysed. Results Among sixteen PKT patients, 15 were included. Seven patients (47%) developed an invasive fungal infection, exclusively IAFI (six proven, one probable). The proven IAFI included four peritonitis, one pancreatic necrosis with infected hematoma, and one patient with positive preservation fluid only (PF). Candida albicans (n = 4) was the most prevalent species (associated with Galactomyces candidus in one case), C glabrata, C dubliniensis, and C krusei were found in one case each. Three patients had either a positive direct examination and/or culture for renal or pancreatic PF and the culture of PF was positive for the same species that caused IAFI. IAFIs were significantly associated with pancreatic graft arterial thrombosis (5/7 vs 0/8, P = .007) and fungal contamination of PF (3/7 vs 0/8, P = .008). Among patients with IAFI, all required an early surgical revision post‐transplantation [1‐18 days] and six had early or delayed pancreatic graft removal. One patient died in the first post‐transplant year. Conclusion IAFI is a common complication in PKT, associated with pancreatic graft thrombosis or fungal contamination of the graft PF, and can sometimes lead to pancreatic detransplantation.

Fluconazole versus micafungin for initial antifungal prophylaxis against Candida in pancreas transplant recipients: A comparative study of two consecutive periods

“…3 On the contrary, 47% of PTRs developed IFI despite the administration of prophylaxis with fluconazole for 7 days in a recently published French series that only included 16 patients. 6 This large disparity in incidence rates might be justified, among other reasons, by the disparate criteria applied to define infection across available studies.…”

“…The incidence of IFI was estimated at 8% in an Austrian study that included 72 PTRs with enteric exocrine pancreas drainage and fluconazole prophylaxis between 2002 and 2004 3 . On the contrary, 47% of PTRs developed IFI despite the administration of prophylaxis with fluconazole for 7 days in a recently published French series that only included 16 patients 6 . This large disparity in incidence rates might be justified, among other reasons, by the disparate criteria applied to define infection across available studies.…”

“…Some transplant groups have opted for not administering prophylaxis, 5 although most of them adopted an universal approach based on the use of fluconazole during the early post-transplant period. 2,6,7 Micafungin is an equinocandin that exhibits a wider spectrum of activity against non-albicans Candida species than fluconazole.…”

“…Scarce evidence is available to define the best strategy for antifungal prophylaxis in order to reduce the incidence of invasive candidiasis among PTRs. Some transplant groups have opted for not administering prophylaxis, 5 although most of them adopted an universal approach based on the use of fluconazole during the early post‐transplant period 2,6,7 …”

Epidemiology of Invasive Fungal Infections in Solid Organ Transplant Recipients: an Indian Perspective

“…The authors also reported that fungal infections were independent risk factors for severe pancreatic graft dysfunction [ 71 ]. A French cohort analyzing 15 patients of KPT over 11 years reported IFI in seven (47%) cases, all being IC [ 72 ]. There were four cases of C. albicans and one each of C. glabrata , C. dubliniensis , and C. krusei .…”