Systemic Fungal Infections after Renal Transplantation

Abstract

In a retrospective evaluation, the incidence of systemic fungal infections (SFIs) in 296 kidney graft recipients admitted to our center between 1986 and 1999 was found to be 4%. Eighteen percent of 28 recipients transplanted in India and 8% of 12 recipients transplanted in Russia developed SFI. In contrast, SFI was encountered in only 2% of recipients transplanted at our center. The median time of diagnosis of SFI was 5 months after transplantation. The lungs and central nervous system were the most frequently affected sites. The most common etiologic agent was Aspergillus fumigatus (n = 7) but Candida spp. (n = 1), Rhizopus spp. (n = 1) and Cryptococcus neoformans (n = 1) were also encountered. In 2 patients, 2 different pathogens were isolated at the same time: A. fumigatus and Rhizopus spp. in 1 patient and Candida spp. and A. fumigatus in another. In order to determine predisposing factors for SFI, patients admitted immediately before and after those with SFI were used as controls: long-term hospitalization, long-term antibiotic use and post-transplant diabetes mellitus were found to be predisposing factors. Eight patients were treated with antifungal drugs and a good response to liposomal amphotericin B therapy was obtained in 3/5. Nine patients (75%) with SFI died. As SFIs are associated with a high mortality rate in renal transplant recipients, antifungal therapy, especially with liposomal amphotericin B, should be started whenever fungal infection is suspected, even before the results of microbiologic and/or histologic examinations are known.

AspergillusInfections in Transplant Recipients

“…In renal transplant recipients, invasive aspergillosis has been reported in ϳ0.7% and in up to 4% of patients (9,37,56,88,106,214,237,243,332). Despite a relatively lower overall incidence compared to other organ transplant recipients, invasive aspergillosis is a significant contributor to morbidity in renal transplant recipients.…”

Invasive Aspergillosis in Solid Organ Transplant Recipients

“…Invasive aspergillosis has been reported in approximately 0.7% and in up to 4% of the renal transplant recipients (5,6,(19)(20)(21)(22)(23)(24). High doses and prolonged duration of corticosteroids, graft failure requiring hemodialysis and potent immunosuppressive therapy have been shown to be risk factors for invasive aspergillosis after renal transplantation (5,22,25).…”

Cytomegalovirus and Aspergillus spp. coinfection in organ transplantation: a case report and review of the literature

“…infection is a devastating complication following solid organ transplantation, with associated high mortality. It typically develops within the first 12 months and is most often seen within the first 3 months after transplantation [2]. Presenting symptoms are usually nonspecific, including low-grade fever, weight loss, fatigue, and dry cough [13].…”

“…Although cytomegalovirus (CMV) rarely develops as a primary infection, reactivation of a previous CMV infection or the development of a superinfection often occur in transplant patients. It has been shown that CMV can lead to the development of bacterial and fungal superinfections by trigger cellular immunosuppression in solid organ transplant patients with a history of CMV infection [2,3]. However, concomitant CMV infection and Aspergillus spp.…”