Related Experiment Videos
Systemic fungal infections after renal transplantation
Mehmet Riza Altiparmak1, Suheyla Apaydin, Sinan Trablus
1Department of Internal Medicine, Cerrahpasa Medical Faculty, University of Istanbul, Turkey.
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.
Insights
Systemic fungal infections (SFIs) affect 4% of kidney transplant recipients, with lungs and CNS commonly impacted. Early antifungal therapy, particularly liposomal amphotericin B, is crucial due to high mortality rates.
Area of Science:
- Nephrology
- Infectious Diseases
- Mycology
Background:
- Systemic fungal infections (SFIs) pose a significant threat to kidney transplant recipients.
- Understanding the incidence, risk factors, and outcomes of SFIs is critical for improving patient survival.
Purpose of the Study:
- To evaluate the incidence, clinical characteristics, predisposing factors, and outcomes of systemic fungal infections in kidney transplant recipients.
- To assess the efficacy of antifungal therapy, including liposomal amphotericin B.
Main Methods:
- Retrospective evaluation of 296 kidney graft recipients.
- Analysis of SFI incidence, affected sites, causative agents, and predisposing factors.
- Review of treatment responses and mortality rates.
Main Results:
- Overall SFI incidence was 4%, with higher rates in recipients transplanted abroad (18% in India, 8% in Russia) versus the local center (2%).
- Common sites were lungs and CNS; Aspergillus fumigatus was the most frequent pathogen.
- Predisposing factors included long-term hospitalization, antibiotic use, and post-transplant diabetes mellitus.
- Liposomal amphotericin B showed a good response in 3/5 patients; overall mortality was 75%.
Conclusions:
- SFIs are associated with high mortality in kidney transplant recipients.
- Prompt empirical antifungal therapy, especially with liposomal amphotericin B, is recommended upon suspicion of fungal infection.