Mortality Predictors Defined in Transplants
Kidney, liver insufficiency increases death risk in recipients with candidemia.
Researchers collected data from 31,667 transplant recipients from 25 academic transplant centers from March 2001 to May 2006. They analyzed Candida species, underlying diseases, and all-cause mortality at 12 weeks after the diagnosis of candidemia. Mortality data were available for 550 men and women with candidemia (mean age 43.7 years; 54% male).
Of these, 247 (45%) had renal insufficiency and 122 (22%) had hepatic insufficiency. The causative organisms were Candida glabrata (32%), Candida albicans (28%), Candida parapsilosis (15%), Candida krusei (8.5%), Candida tropicalis (7.6%), and other Candida species (9%). Other underlying factors included neutropenia (37%) and graft-versus-host disease (23%).
Mortality rates were 45% higher in the 265 patients with hematopoietic stem cell transplants (HSCT) than in the 285 solid organ transplant (SOT) recipients (of whom 82 had kidney transplants). Species-related mortality was highest with C. tropicalis (52%) and lowest with C. parapsilosis (39%). C. glabrata was the most common cause of candidemia among HSCT patients (30%) and C. albicans was the most common among SOT patients (33%).
Among the SOT patients with candidemia, hepatic insufficiency in-creased death risk more than threefold and renal insufficiency increased death risk by nearly twofold. Renal insufficiency, hepatic insufficiency, and HSCT were independently associated with mortality, the researchers concluded. In HSCT patients with candidemia, hepatic and renal insufficiency was associated with a 2.3 times higher risk of death.
“This is the largest collection of transplant patients with candidemia to date,” said lead investigator John Baddley, MD, assistant professor of medicine at the