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The feared five fungal infections in kidney transplant recipients: A single‐center 20‐year experience
Author(s) -
Parajuli Sandesh,
Wick Alexandra,
Pandeya Sameer,
Astor Brad C.,
Smith Jeannina,
Djamali Arjang,
Mandelbrot Didier A.
Publication year - 2018
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13289
Subject(s) - histoplasmosis , medicine , aspergillosis , blastomycosis , cryptococcosis , mycosis , amphotericin b , mucormycosis , surgery , kidney transplantation , univariate analysis , sporotrichosis , transplantation , immunology , multivariate analysis , dermatology , antifungal
Invasive fungal infections are a feared complication in kidney transplant recipients ( KTR s). Here we present the University of Wisconsin experience with 5 invasive fungal infections—aspergillosis, cryptococcosis, histoplasmosis, blastomycosis, and coccidioidomycosis—in KTR s transplanted between 01/01/1994 and 06/30/2014. During this period, there were 128 cases of fungal infections; aspergillosis was the most common (72), followed by cryptococcosis (29), histoplasmosis (14), blastomycosis (10), and coccidioidomycosis (3). The mean interval from transplant to fungal infection was 3.19 ± 3.58 years (range 5 days‐15.8 years). By 6 months postinfection, there were 53 (41%) graft failures and 24 (19%) deaths. Graft failure occurred in 46%, 38%, 21%, 40%, and 67% of patients with aspergillosis, cryptococcosis, histoplasmosis, blastomycosis, and coccidioidomycosis, respectively. Anti‐thymocyte globulin ( ATG ) induction ( HR , 1.49; 95% CI , 1.03‐2.16; P = .04), diabetes ( HR , 1.53; 95% CI , 1.05‐2.21; P = .03), and age ( HR , 1.47; 95% CI , 1.27‐1.70; P ≤ .001) were associated with an increased risk for infection in univariate analysis. Multivariate adjustment retained ATG induction and older age. A large proportion of kidney transplant recipients with invasive fungal infections suffer graft failure within 3 years. Preventive, therapeutic, and monitoring strategies are needed to improve graft and patient outcomes.