Kidney, liver insufficiency increases death risk in recipients with candidemia.


SAN DIEGO—Transplant patients suffering from candidemia are more likely to die if they have renal or hepatic insufficiency, data show.

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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 University of Alabama at Birmingham. “Because of these large numbers we were able to evaluate risk factors that had not been previously described in transplant patients. We clearly found that in transplant patients, renal insufficiency is related to death, which suggests that renal function needs careful monitoring. We were also surprised to find that more than 40% of the patients had renal insufficiency at the time of the diagnosis of the Candida infection, which is higher than we expected.” He presented findings here at the annual meeting of the Infectious Diseases Society of America.


Until now, predictors of mortality in transplant patients with candidemia had been poorly defined, Dr. Baddley said. He and his colleagues used data from the Transplant-Associated Infection Surveillance Network (TRANSNET), a prospective study of invasive fungal infections in transplant patients. The researchers evaluated candidemia epidemiology and factors related to mortalit