Hospitalizations for fungal infections after renal transplantation in the United States

Abstract

Fungal infections in renal transplant recipients have not been studied in a national population. Therefore, 33,420 renal transplant recipients in the United States Renal Data System from 1 July 1994 to 30 June 1997 were analyzed in a retrospective registry study of hospitalized fungal infections (FI). FI were most commonly associated with secondary diagnoses of esophagitis (68, 23.9%), pneumonia (57, 19.8%), meningitis (23, 7.6%), and urinary tract infection (29, 10.3%). Opportunistic organisms accounted for 95.4% of infections, led by candidiasis, aspergillosis, cryptococcosis, and zygomycosis. Most fungal infections (66%) had occurred by six months post-transplant, but only 22% by two months. In logistic regression analysis, end-stage renal disease due to diabetes, duration of pre-transplant dialysis, maintenance tacrolimus and allograft rejection were associated with FI. In Cox regression analysis, recipients with FI had a relative risk of mortality of 2.88 (95% CI=2.22-3.74) compared to all other recipients. Among FI, zygomycosis and aspergillosis were independently associated with both increased patient mortality and length of hospital stay. Most fungal infections in renal transplant recipients were opportunistic, occurred later than previously reported, and were associated with greatly decreased patient survival. Recipients with diabetes, prolonged pre-transplant dialysis, rejection, and tacrolimus immunosuppression should be considered high risk for FI.

Common Infections in Kidney Transplant Recipients

“…Which infections develop depend in part on the patient's specific exposure history as well as the nature of the exposure and the net state of immunosuppression. The three leading sites of fungal infections in hospitalized kidney transplant recipients are esophageal candidiasis, pneumonia, and urogenital candidiasis (93). Risk factors for fungal infections in transplant recipients include the use of large doses of corticosteroids, multiple or recent rejection episodes, hyperglycemia, poor transplant function, leukopenia, and older age (15).…”

Effect of Diabetes Mellitus on Mycophenolate Sodium Pharmacokinetics and Inosine Monophosphate Dehydrogenase Activity in Stable Kidney Transplant Recipients

“…A post hoc analysis of data from clinical trials converting kidney transplant recipients from a MMF to an EC-MPS regimen showed that EC-MPS is safe and effective in patients with diabetes; however, the pharmacokinetics of EC-MPS in patients with diabetes has never been characterized. 9 Diabetic kidney transplant recipients are generally more susceptible to infection because of reduced innate immunity, 1,[10][11][12] but the effect of diabetes on the molecular target for MPA [inosine 5′-monophosphate dehydrogenase (IMPDH)] is not known. Because kidney transplant recipients are maintained on large daily doses of immunosuppressive agents, it is important to determine whether immunologic differences exist between diabetic and nondiabetic patients so the immunosuppressive regimen can be tailored to the individual needs of each patient.…”

Paranasal Aspergillosis in Patients Prior to Liver Transplantation

“…간이식수술 후 이식거부 반응을 막기 위해 모든 환자에서 면역억제 제를 광범위하게 사용하기 때문에 이식수술 후에는 면역 력이 낮아져 진균 감염의 가능성이 수술 전보다 높아지 게 된다 (6)(7)(8). 간이식수술을 받은 환자에게 있어서 진균 감염에 대한 치료 및 예방은 매우 중요하다 (9).…”