Incidence and outcomes of invasive fungal infection among solid organ transplant recipients: A population‐based cohort study

Abstract

Background Invasive fungal infection (IFI) in solid organ transplant (SOT) recipients is associated with significant morbidity and mortality. The long‐term probability of post‐transplant IFI is poorly understood. Methods We conducted a population‐based cohort study using linked administrative healthcare databases from Ontario, Canada, to determine the incidence rate; 1‐, 5‐, and 10‐year cumulative probabilities of IFI; and post‐IFI all‐cause mortality in SOT recipients from 2002 to 2016. We also determined post‐IFI, death‐censored renal allograft failure. Results We included 9326 SOT recipients (median follow‐up: 5.35 years). Overall, the incidence of IFI was 8.3 per 1000 person‐years. The 1‐year cumulative probability of IFI was 7.4% for lung, 5.4% for heart, 1.8% for liver, 1.2% for kidney‐pancreas, and 1.1% for kidney‐only allograft recipients. Lung transplant recipients had the highest incidence rate and 10‐year probability of IFI: 43.0 per 1000 person‐years and 26.4%, respectively. The 1‐year all‐cause mortality rate after IFI was 34.3%. IFI significantly increased the risk of mortality in SOT recipients over the entire follow‐up period (hazard ratio: 6.50, 95% CI: 5.69‐7.42). The 1‐year probability of death‐censored renal allograft failure after IFI was 9.8%. Conclusion Long‐term cumulative probability of IFI varies widely among SOT recipients. Lung transplantation was associated with the highest incidence of IFI with considerable 1‐year all‐cause mortality.

Evaluation of targeted versus universal prophylaxis for the prevention of invasive fungal infections following lung transplantation

“…We compared a universal antifungal prophylaxis strategy with a targeted antifungal prophylaxis strategy for prevention of IFI following lung transplant and found that the risk of developing an IFI in the 18 months following transplant was significantly greater in the cohort receiving targeted prophylaxis. The 10% incidence of IFIs in the universal prophylaxis cohort was similar to that reported from other single and multi‐center experiences 2,4,13 . However, the 30% incidence of IFIs in the targeted prophylaxis cohort was higher than that noted in most prior studies of IFI in lung transplant recipients 2,13,14 …”

“…The 10% incidence of IFIs in the universal prophylaxis cohort was similar to that reported from other single and multi‐center experiences 2,4,13 . However, the 30% incidence of IFIs in the targeted prophylaxis cohort was higher than that noted in most prior studies of IFI in lung transplant recipients 2,13,14 …”

Strategies for the Prevention of Invasive Fungal Infections after Lung Transplant

“…Despite advances in donor selection, surgical techniques, and immunosuppressive regimens, long-term survival after lung transplantation has only slightly improved throughout the last two decades, and the 5-year survival post-transplant is still around 50%-60% [1]. Invasive fungal diseases (IFDs) significantly contribute to the mortality seen among lung transplant recipients (LTRs) [2][3][4][5]. In a single-center study in the US, IFD was identified as the strongest predictor for mortality in these patients [6].…”

Disseminated cryptococcosis with cutaneous manifestation

“…Cryptococcosis is the third most common invasive fungal infection in solid organ transplant (SOT) recipients after candidiasis and aspergillosis 1 . In a recent study from Canada, where Pneumocystis jiroveci was relatively common, crytococcosis lost its place to the fourth position among the common invasive fungi in SOT 2 . It usually occurs more than a year after transplant with a median time of onset of 575 days following transplant 1 .…”