Risk Factors Associated With Invasive Fungal Infections in Kidney Transplant Patients

Leitheiser, Sara; Harner, Andrew; Waller, Jennifer L.; Turrentine, Jake E.; Baer, Stephanie L.; Kheda, Mufaddal; Nahman, N. S.; Colombo, Rhonda E

doi:10.1016/j.amjms.2019.10.008

Cited by 19 publications

(17 citation statements)

References 19 publications

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“…Our findings corroborate international data, in which candidemia is the most common IFI in solid organ transplants (SOT) (Gavalda, et al, 2014). Chronic liver disease has already been identified as an important and independent risk factor for candidemia in transplant recipients, a fact that may justify the high frequency of this infection in liver transplant patients in the present study (Leitheiser, et al, 2019). Among the eight liver recipients, six developed candidemia, and of the 15 kidney recipients, only three acquired this condition.…”

Section: Discussionsupporting

confidence: 92%

Invasive fungal infections in kidney and liver transplant recipients in a center in northeast Brazil

Holanda¹,

Oliveira

Leitão³

et al. 2021

RSD

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Objective: Describe the main invasive fungal infections (IFIs) after kidney and liver transplantation at a referral center, as well as their evolution, treatment, and clinical features. Material and Methods: This was a retrospective, observational, descriptive, case series study involving IFIs diagnosed between January 2012 and December 2019 in kidney and liver transplant recipients. Results: Among 769 kidney transplants, only 1 patient received the organ from a living donor and the other transplants were from deceased donors. 15 IFIs were diagnosed (7 histoplasmoses, 4 cryptococcoses, 3 candidemias, and 1 aspergillosis), while in 673 liver transplants, 8 IFIs were diagnosed (6 candidemias, 1 murcomycosis, and 1 cryptococcosis). Of the total 23 patients, 6 (26%) had infection diagnosed within 6 months after transplantation. The primary immunosuppressive regimen used was tacrolimus (82.6%), prednisone (82.6%), and mycophenolate (56.5%). Amphotericin B deoxycholate was the leading antifungal agent used for treatment, with nephrotoxicity in 80% of the cases. In the clinical follow-up, 14 patients progressed to cure (60.9%) and 9 to death (39.1%). A worsening of renal function was observed in most patients in the present study. Conclusion: Candidemia, histoplasmosis, and cryptococcosis were the most frequent IFIs, with the majority occurring later, 6 months after transplantation, and associated with high mortality.

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Section: Discussionsupporting

confidence: 92%

Invasive fungal infections in kidney and liver transplant recipients in a center in northeast Brazil

Holanda¹,

Oliveira

Leitão³

et al. 2021

RSD

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“…Therefore, both were included in the systematic review. The studies by Abbott, 24 Zhang, 25 and Leitheiser et al 26 were excluded because the criteria applied for defining IA could not be verified in any of them. Methodological quality assessment according to the Newcastle‐Ottawa Scale showed that all the studies scored ≥ 5 stars, suggesting moderate to high quality (Table 1).…”

Section: Resultsmentioning

confidence: 99%

Risk factors for the development of invasive aspergillosis after kidney transplantation: Systematic review and meta-analysis

Asín

López‐Medrano

Fernández‐Ruiz

et al. 2021

American Journal of Transplantation

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To investigate risk factors for invasive aspergillosis (IA) after kidney transplantation (KT), we conducted a systematic search in PubMed and EMBASE to identify studies published until June 2020. We included case‐control or cohort design studies comprising KT recipients with a diagnosis of IA, defined according to the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group criteria, and assessed risk factors for the development of IA. Random‐effect models meta‐analysis served to pool data. We identified eleven case‐control studies (319 IA cases and 835 controls). There was an increased risk of IA among recipients with underlying chronic lung diseases (odds ratio [OR] = 7.26; 95% confidence interval [CI] = 1.05‐50.06) and among those with diabetic nephropathy (OR = 1.65; 95% CI = 1.10‐2.48). Requiring posttransplant hemodialysis (OR = 3.69; 95% CI = 2.13‐6.37) or surgical reintervention (OR = 6.28; 95% CI = 1.67‐23.66) were also associated with an increased risk. Moreover, a positive link was identified between IA and posttransplant bacterial infection (OR = 7.51; 95% CI = 4.37‐12.91), respiratory tract viral infection (OR = 7.75; 95% CI = 1.60‐37.57), cytomegalovirus infection or disease (OR = 2.67; 95% CI = 1.12‐6.32), and acute graft rejection (OR = 3.01; 95% CI = 1.78‐5.09). In contrast, receiving a kidney from a living donor was associated with a reduced risk (OR = 0.65; 95% CI = 0.46‐0.93). KT recipients that accumulate several of these conditions should be closely monitored and a low threshold of suspicion for IA should be maintained. Future studies should explore the benefit of mold‐active prophylaxis to this subgroup of KT recipients at highest risk.

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“…Among the endemic myoses in solid-organ transplant recipients, histoplasmosis is most frequent, causing 5%-9% of post-transplant invasive fungal infections when early infections with Aspergillus and Candida are included (80,81). Histoplasmosis occurs in 0.1%-0.3% of kidney transplant recipients, at median of 2-5 years post-transplant (81)(82)(83).…”

Section: Fungal Infectionsmentioning

confidence: 99%

Long-Term Infectious Complications of Kidney Transplantation

Agrawal

Ison

Danziger‐Isakov

2022

CJASN

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Infections remain a common complication of solid-organ transplantation. Most infections in the first month after transplant are typically health care–associated infections, whereas late infections, beyond 6–12 months, are community-acquired infections. Opportunistic infections most frequently present in the first 12 months post-transplant and can be modulated on prior exposures and use of prophylaxis. In this review, we summarize the current epidemiology of postkidney transplant infections with a focus on key viral (BK polyomavirus, cytomegalovirus, Epstein-Barr virus, and norovirus), bacterial (urinary tract infections and Clostridioides difficile colitis), and fungal infections. Current guidelines for safe living post-transplant are also summarized. Literature supporting prophylaxis and vaccination is also provided.

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Risk Factors Associated With Invasive Fungal Infections in Kidney Transplant Patients

Cited by 19 publications

References 19 publications

Invasive fungal infections in kidney and liver transplant recipients in a center in northeast Brazil

Invasive fungal infections in kidney and liver transplant recipients in a center in northeast Brazil

Risk factors for the development of invasive aspergillosis after kidney transplantation: Systematic review and meta-analysis

Long-Term Infectious Complications of Kidney Transplantation

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