Coccidioidomycosis Ups Death Risk in Organ Recipients

Organs from CI-positive donors were associated with higher mortality.
Organs from CI-positive donors were associated with higher mortality.

NEW ORLEANS – While coccidioidomycosis (CI) is a rare finding in organ donors even from CI-endemic areas, unrecognized CI can result in increased mortality in patients needing organ transplantation, according to a presentation at IDWeek 2016.

Using data from the Donor Network West, Nikeshan Jeyakumar, MHS, from the Department of Medicine at the University of Miami, Florida, and colleagues conducted a retrospective cross-sectional study of all potential organ donors from January 2014 to February 2016. Prevalence of CI was determined by positive medical history, positive serology, or organ biopsy. The study compared survival in patients who received organ transplantation from CI-infected and uninfected donors.

A total of 654 donors were tested for CI, 11 of which who were found to be positive for CI.  Seven of these 11 individuals eventually provided 26 organs for 22 recipients. Three of 6 deceased recipients were found to have “definitive evidence of fungal infection and their deaths were likely related to CI transmission,” the researchers observed.

Of the patients who received organ transplantations from CI-negative donors, 4.5% (78) died following transplantation.  The data revealed that organs from CI-positive donors were associated with higher mortality (odds ratio [OR] 8.0, 95% Confidential Interval [CI] 3.0 to 21.0, P <.0001); however, the mean time between organ transplantation and death did not differ depending on CI status.

“Unrecognized CI can result in increased mortality in recipients,” the researchers concluded. In order to improve patient safety and reduce CI-associated morbidity and mortality, targeted screening needs to occur of “donors from endemic areas; those with a history of incarceration or calcifications on chest imaging; or those with immunosuppression at the time of donation.”

Future studies will need to include a larger number of organ donors with CI as well as recipients in order to develop a screening algorithm for organ donors with CI.

Reference

1. Jeyakumar N, Neidlinger N, Carpenter T, Brown C, Salvatore M, Chin-Hong P. High mortality associated with donor-derived coccidioidomycosis in a population-based study of potential organ donors in California. Presented at: IDWeek 2016. New Orleans, LA; October 26-30, 2016. Abstract 80.

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