Epidemiology, outcomes, and mortality predictors of invasive mold infections among transplant recipients: a 10‐year, single‐center experience

Abstract

Background The epidemiology of invasive mold infections (IMI) in transplant recipients differs, based on geography, hosts, preventative strategies, and methods of diagnosis. Methods We conducted a retrospective observational study to evaluate the epidemiology of proven and probable IMI, using prior definitions, among all adult hematopoietic stem cell (HSCT) and solid organ transplant (SOT) recipients in the era of “classic” culture-based diagnostics (2000–2009). Epidemiology was evaluated before and after an initiative was begun to increase bronchoscopy in HSCT recipients after 2005. Results In total, 106 patients with one IMI were identified. Invasive aspergillosis (IA) was the most common IMI (69; 65.1%), followed by mucormycosis (9; 8.5%). The overall rate of IMI (and IA) was 3.5% (2.5%) in allogeneic HSCT recipients. The overall incidence for IMI among lung, kidney, liver, and heart transplant recipients were 49, 2, 11, and 10 per 1000 person-years, respectively. The observed rate of IMI among HLA-matched unrelated and haploidentical HSCT recipients increased from 0.6% annually to 3.0% after bronchoscopy initiation (P<0.05). The 12-week mortality among allogeneic HSCT, liver, kidney, heart, and lung recipients with IMI was 52.4%, 47.1%, 27.8%, 16.7%, and 9.5%, respectively. Among allogeneic HSCT (odds ratio [OR]: 0.07, P=0.007) and SOT (OR: 0.22, P=0.05) recipients with IA, normal platelet count was associated with improved survival. Male gender (OR: 14.4, P=0.007) and elevated bilirubin (OR: 5.7, P=0.04) were significant predictors of mortality for allogeneic HSCT and SOT recipients with IA, respectively. Conclusions During the era of culture-based diagnostics, observed rates of IMI were low among all transplants except lung transplant recipients, with relatively higher mortality rates. Diagnostic aggressiveness and host variables impact the reported incidence and outcome of IMI and likely account for institutional variability in multicenter studies. Definitions to standardize diagnoses among SOT recipients are needed.

Invasive Fungal Infections After Kidney Transplantation: A Single-center Experience

“…With respect to aspergillosis, median time at diagnosis of infection was 175 days post-transplantation, which is in line with other studies [3,18]. Clinical presentation was consistent with remarkable literature on this infection [19].…”

Aspergillus Infections in Transplant and Non-Transplant Surgical Patients

“…Multiple studies have shown that lung transplant recipients experience a higher incidence of aspergillosis than do recipients of other solid-organ transplants. This, coupled with the poor radiographic imaging resulting from post-operative changes in lung-transplant recipients, has prompted the recommended use of antifungal prophylaxis in this population [22][23][24][25][26]. Other studies have demonstrated a difference in the time of onset of infection and death among lung-transplant recipients, with patients experiencing Aspergillus infections of late-onset having a significantly higher mortality than those with infections of early onset [25].…”

Antifungal Clinical Trials and Guidelines: What We Know and Do Not Know

“…Worldwide, there are large numbers of cases of aspergillosis in the general population, including patients with allergic bronchopulmonary aspergillosis, pulmonary aspergillomata (mycetoma), chronic necrotizing pulmonary aspergillosis, and invasive pulmonary aspergillosis among chronically immunocompromised and ICU patients. However, IA is the most impactful in terms of patient outcomes among allogeneic stem cell transplant recipients, patients with hematologic malignancies undergoing chemotherapeutic bone marrow ablation, and high-risk solid organ transplant recipients, especially lung transplant recipients Neofytos et al 2013). Clinical trials involving patients with IA have generally focused on these high-risk populations.…”