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Investigating the Immunological Mechanisms Underlying Organ Transplant Rejection
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Published on: August 20, 2007

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Epidemiological features of invasive mold infections among solid organ transplant recipients: PATH Alliance® registry

Shahid Husain1, Fernanda P Silveira2, Nkechi Azie3

  • 1Multi-organ Transplant Program, Infectious Diseases Division, University Health Network, University of Toronto, 11 PMB 138, 585 University Avenue, Toronto, ON, M5G 2N2, Canada.

Medical Mycology
|October 6, 2016
PubMed

Insights

Solid organ transplant recipients (SOTRs) face invasive mould infections (IMIs). Liver transplant recipients (LTRs) experience earlier IMIs, higher disseminated disease rates, and worse outcomes compared to other SOTRs.

Area of Science:

  • Infectious Diseases
  • Transplantation Medicine
  • Mycology

Background:

  • Invasive mould infections (IMIs) are a significant concern in solid organ transplant recipients (SOTRs).
  • Understanding the epidemiological characteristics of IMIs is crucial for improving patient outcomes.

Purpose of the Study:

  • To present the epidemiological characteristics of 333 proven and probable IMIs in SOTRs.
  • To compare IMI incidence, disease dissemination, mortality, and treatment response across different SOTR groups.
  • To identify risk factors and inform antifungal strategies.

Main Methods:

  • Analysis of data from 333 SOTRs with IMIs from the Prospective Antifungal Therapy Alliance (PATH) registry (2004-2008).
  • Comparison of epidemiological features, including time to IMI, disseminated disease rates, and mortality, among different transplant types (e.g., liver, lung).
  • Evaluation of treatment response rates for invasive aspergillosis and mucormycosis.

Main Results:

  • Liver transplant recipients (LTRs) had the shortest median time to IMI (109 days), highest disseminated disease rate (55%), and highest mortality (64%).
  • Lung transplant recipients (LTRs) had the longest median time to IMI (486 days) and lowest mortality (17%).
  • Treatment response at week 12 was 67% for invasive aspergillosis and 41% for mucormycosis. LTRs showed the worst composite outcome of death or no response.

Conclusions:

  • LTRs represent a high-risk group for severe IMIs with poorer prognoses.
  • Increased vigilance for mold infections and proactive antifungal prophylaxis are recommended, particularly for LTRs.
  • Tailored antifungal strategies based on transplant type and IMI characteristics are warranted.
Keywords:
Invasive mould infectionsPATH Alliance® registryliver transplantsolid organ transplant

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