Post-Transplant Fungal Infections Remain Problematic

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Fungal infections, especially invasive candidiasis and invasive aspergillosis, remain problematic among solid organ transplant recipients (SOT), but overall mortality appears to have improved, new findings confirm.

A team led by Dionissios Neofytos, MD, PhD, of The Johns Hopkins University in Baltimore, identified 429 adult SOT recipients with 515 invasive fungal infections (IFIs).

Candida species caused 304 (59%) IFIs, Aspergillus species caused 128 (24.8%), and Cryptococcus species caused 36 (7%), the investigators reported in Transplant Infectious Disease (2010; published online ahead of print). Invasive candidiasis was the most common IFI in all groups except for lung recipients, in whom aspergillosis was the most common.

Of the 109 IFIs in kidney recipients, Candida species caused 66 (60.6%), Cryptococcus species caused 21 (19.3%), and Aspergillus species caused 13 (11.9%). Kidney recipients had the highest percentage of cryptococcal infections (58.3%) of all the transplant categories.

Liver recipients had the second highest, with nine cases (25%). In both groups, most cases developed between two and five years after transplantation (median 805.5 days and 500.5 days for kidney and liver recipients, respectively).Twelve weeks after diagnosis of the infections, 71.4% of all patients with these infections were alive.

Nearly half of invasive candidiasis cases in liver, heart, and lung transplant recipients occurred during the first 100 days after transplantation. More than half of the invasive aspergillosis cases in lung recipients occurred more than one year post-transplant.

The overall 12-week mortality was 29.6%, which the investigators said “is markedly improved from previously reported rates.” Liver recipients had the highest mortality.

Organ damage, neutropenia, and administration of corticosteroids independently predicted mortality.

Of the 429 patients in the study, 362 received a single organ (108 livers, 106 lungs, 97 kidneys, 36 hearts, 12 small bowels, two islet cells, and one pancreas) and 59 received two organs (31 kidney-pancreas, 17 kidney-liver, three lung-heart, two kidney-lung, two kidney small bowel, two liver-small bowel, one liver-lung, and one liver-pancreas. Seven patients received three organs—six liver-pancreas-small bowel and one kidney-pancreas-small bowel—and one patient received four organs (kidney-liver-pancreas-small bowel).

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