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Published on: April 13, 2021
Invasive aspergillosis in kidney transplant recipients: a cohort study
Maria José Pérez-Sáez1, Marisa Mir, Maria Milagro Montero
1Department of Nephrology, Hospital del Mar, Barcelona, Spain.
Objectives:
Fungal infections represent 5% of infections in renal transplant recipients. Candidiasis is the most frequent, followed by aspergillosis and cryptococcosis. Invasive aspergillosis is severe and has a poor prognosis, but recent series focused on outcomes are scarce in the literature. We analyzed invasive aspergillosis cases in a cohort of kidney transplant recipients and suggest that prognosis is improved with early diagnosis and treatment.
Patients And Methods:
A retrospective study was performed in all kidney transplant undertaken in our hospital from January 1979 to December 2012. The incidence and characteristics of invasive aspergillosis were collected from kidney transplant prospective registry and microbiology laboratory.
Results:
We found 7 invasive aspergillosis cases (6 probable invasive aspergillosis and 1 possible invasive aspergillosis, according to EORTC/IFICG criteria); cumulative incidence 0.78% (7/891). The median posttransplant time until the disease onset was 3.03 months (interquartile range, 2.4-3.2 months), with a mean age of 56 years at the time of diagnosis. Six patients were male. Four patients had previous pulmonary disease. Six patients had received induction therapy (5 anti-IL2R antibodies, 1 with antilymphocytic antibodies). Two patients had received extra immunosuppression (1 with thymoglobulin to treat an acute rejection and the other 1 had a lymphoproliferative disorder and was on chemotherapy). Six patients were on calcineurin inhibitors at the time of diagnosis. Aspergillus fumigatus was the specimen most commonly isolated (6 cases). Six patients had a bacterial coinfection and 1 had a cytomegalovirus coinfection. All patients were treated with antifungal agents; 3 of which received voriconazole. Four patients satisfactorily resolved the episode and 3 died.
Conclusions:
Invasive aspergillosis incidence is low in kidney transplant although potentially lethal. We observed an acceptable survival of patients analyzed, better than usually reported. A high index of suspicion is essential to get an early diagnosis and start treatment.
Insights
Invasive aspergillosis is a rare but serious fungal infection in kidney transplant patients. Early diagnosis and treatment of invasive aspergillosis in transplant recipients can improve patient survival rates.
Area of Science:
- Nephrology
- Transplantation
- Infectious Diseases
Background:
- Fungal infections, particularly candidiasis, aspergillosis, and cryptococcosis, are significant concerns in renal transplant recipients.
- Invasive aspergillosis (IA) presents a severe threat with a poor prognosis, yet recent outcome data are limited.
- This study addresses the scarcity of recent literature on IA outcomes in this vulnerable population.
Purpose of the Study:
- To analyze cases of invasive aspergillosis in a cohort of kidney transplant recipients.
- To determine the incidence, characteristics, and outcomes of IA in this patient group.
- To emphasize the importance of early diagnosis and treatment for improved prognosis.
Main Methods:
- A retrospective study analyzed kidney transplant recipients from January 1979 to December 2012.
- Data on IA incidence and characteristics were gathered from a prospective registry and microbiology laboratory.
- EORTC/IFICG criteria were used to classify IA cases.
Main Results:
- Seven cases of IA were identified (cumulative incidence 0.78%), with a median onset of 3.03 months post-transplant.
- Aspergillus fumigatus was the most common isolate; bacterial and cytomegalovirus coinfections were noted.
- Four out of seven patients survived IA, with three deaths.
Conclusions:
- Invasive aspergillosis is infrequent but potentially fatal in kidney transplant recipients.
- The observed survival rate was acceptable and better than previously reported outcomes.
- A high index of suspicion is crucial for timely diagnosis and initiation of antifungal therapy.
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