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Donor-derived filamentous fungal infections in solid organ transplant recipients

Carlos A Gomez1, Nina Singh

  • 1Department of Medicine, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania 15240, USA.

Current Opinion in Infectious Diseases
|June 29, 2013
PubMed
Abstract

Insights

Donor-derived filamentous fungal infections (DDFFIs) are rare but serious complications in transplant recipients, often linked to donor immunosuppression. Early recognition and treatment are crucial for better graft and patient outcomes.

Area of Science:

  • Transplantation immunology
  • Mycology
  • Infectious diseases

Background:

  • Allografts can transmit rare opportunistic molds, leading to filamentous fungal infections.
  • Epidemiologic and clinical characteristics of donor-derived filamentous fungal infections (DDFFIs) in transplant recipients are not well understood.

Purpose of the Study:

  • To describe donor-related risk factors for DDFFIs.
  • To outline the clinical presentation of DDFFIs.
  • To report graft and recipient outcomes associated with DDFFIs.

Main Methods:

  • Systematic review of reported cases of donor-derived opportunistic filamentous fungal infections.
  • Analysis of donor-related risk factors, clinical manifestations, and outcomes.

Main Results:

  • Twenty-three cases of DDFFIs were reported, predominantly in kidney transplant recipients (91%).
  • Aspergillus spp. was the most common causative organism (71%).
  • Identified risk factors include donor immunosuppression, near-drowning events, and transplant tourism. Manifestations included vascular complications (65%), allograft dysfunction (43%), and febrile illness (39%). Graft loss occurred in 83% and mortality in 17% of cases.

Conclusions:

  • Donor-transmitted filamentous mycoses present a unique spectrum of illness and transmission scenarios.
  • Optimal graft and recipient outcomes necessitate prompt recognition, early surgical intervention, and targeted antifungal therapy.

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