Increased Mortality Among Renal Transplant Patients With Invasive Pulmonary Aspergillus Infection

Abstract

Introduction: Renal transplantation is the most effective and preferred definite treatment option in patients with end-stage renal disease. Due to long-term immunesuppressive treatment, renal transplant recipients become vulnerable to opportunistic infections, especially to fungal infections. Method: This was a single-center, retrospective observational study of 438 patients who underwent renal transplantation between 2010 and 2016. Results: Thirty-eight renal transplant recipients who had lower respiratory tract infection with median age of 41.5 years were evaluated for invasive pulmonary aspergillus (IPA). Of these, 52.6% were female and 84.2% had living donors. Eleven of 38 lower respiratory patients were found to have IPA infection, 5 with proven infection. Compared to patients who did not have fungal pulmonary infection, patients with invasive aspergillus were older and had high fever, galactomannan levels, and leukocyte counts. Mortality was also higher in those patients. Having fever at the baseline and IPA infection was significantly associated with mortality in univariate analysis and remained related in multivariate model after adjustment for age, gender, and fever. Conclusion: Invasive pulmonary aspergillus infection is highly associated with increased mortality rates in renal transplant patients. Fungal pulmonary infections in immune-suppressed patients should be diagnosed and treated immediately in order to avoid the life-threatening complications and may greatly improve prognosis.

Predictors of Adverse Events and Determinants of the Voriconazole Trough Concentration in Kidney Transplantation Recipients

“…However, immunosuppression increases the risk of opportunistic infections and induces the occurrence of secondary fungal infections with high mortality rates (40-60%). 1,3 Voriconazole is the first available second-generation triazole. Experts recommend voriconazole as primary therapy for invasive aspergillosis.…”

“…Kidney transplantation, in conjunction with calcineurin inhibitors, is regarded as the best option for patients with end‐stage kidney disease. However, immunosuppression increases the risk of opportunistic infections and induces the occurrence of secondary fungal infections with high mortality rates (40–60%) 1,3 …”

Invasive Aspergillosis after Renal Transplantation

“…Fungi are responsible for around five percent of all infections in renal-transplanted patients and Aspergillus species is second only to Candida spp. in this cohort [ 7 ]. Invasive aspergillosis (IA) is a life-threatening opportunistic infection in immunocompromised patients including renal transplant recipients [ 8 ].…”

“…A high mortality rate has been observed in IA in renal transplants (40–60%) [ 1 , 12 ]. In some studies, it is as high as 67% to 92%; however, this may be due to the small number of cases of these studies [ 7 , 11 , 13 ]. For example, Gavalda et al observed the death of 7 out of 10 renal transplant recipients with IA in his retrospective case–control study, a 70% mortality [ 13 ].…”

“…For example, Gavalda et al observed the death of 7 out of 10 renal transplant recipients with IA in his retrospective case–control study, a 70% mortality [ 13 ]. Studies observed increased mortality in line with a delay in the diagnosis of IA and a baseline high fever [ 7 ]. In addition, some studies have observed significantly higher mortality rates in those with IA early after transplanation compared to those occurring later [ 2 ].…”