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Infectious diseases in solid organ transplant recipients: Analysis of autopsied cases in Japan
Yuhko Suzuki1, Akira Kenjo2, Tomiteru Togano3
1Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University, Fukushima, Fukushima, Japan.
Background:
With the improvements in immunosuppressive agents and graft survival, infections such as mycoses have become major complications after solid organ transplantation (SOT).
Methods:
Our group has continuously updated an epidemiological database of visceral mycoses (VM) among autopsy cases in Japan since 1989. Data on infectious agents and clinical information were complied using similar procedures.
Results:
Among the all autopsied cases studied, 356 undergone SOT. Of these, 214 (60.1%) suffered from one or more types of infections, including 51 (14.3%) with VM. Thus, the incidence of VM was higher in SOT recipients than in non-transplanted cases (P < 0.0001). Aspergillus spp. (Asp) was the most predominant agent and Candida spp. was second. Specifically, among SOT recipients, Asp was the most predominant in liver and lung transplant recipients. Among the 217 autopsied liver transplants cases, the incidence of VM was highest in those with fulminant hepatitis (FH, P = 0.01). The incidence of cytomegalovirus infection tended to be higher in cases with mycosis (P = 0.06). Multivariate logistic regression analysis identified FH (odds ratio, 3.61, 95% confidence interval 1.34-9.75; P = 0.03) as an independent risk factor for mycosis in liver transplant recipients.
Conclusion:
This epidemiological analysis of autopsied cases provides a strong incentive to intensify efforts to diagnose and treat post-SOT infectious diseases.
Insights
Visceral mycoses (VM) are common after solid organ transplantation (SOT). Fulminant hepatitis increases the risk of VM in liver transplant recipients, highlighting the need for better diagnosis and treatment.
Area of Science:
- Medical Mycology
- Transplant Infectious Diseases
- Epidemiology
Background:
- Infections, particularly mycoses, are significant complications following solid organ transplantation (SOT) due to advancements in immunosuppression and graft survival.
- Visceral mycoses (VM) represent a major concern in the post-transplant period.
Purpose of the Study:
- To analyze the epidemiology of VM in autopsy cases in Japan, focusing on SOT recipients.
- To identify risk factors for VM in SOT recipients, particularly liver transplant recipients.
Main Methods:
- Continuous updating of an epidemiological database of VM in Japanese autopsy cases since 1989.
- Compilation of data on infectious agents and clinical information from autopsy cases, including SOT recipients.
Main Results:
- VM occurred in 14.3% of SOT recipients, a significantly higher incidence than in non-transplanted cases.
- Aspergillus spp. was the most common fungal agent, followed by Candida spp. Aspergillus was predominant in liver and lung transplant recipients.
- Fulminant hepatitis (FH) was identified as an independent risk factor for VM in liver transplant recipients (OR 3.61, P=0.03).
Conclusions:
- This epidemiological study underscores the high incidence of VM in SOT recipients.
- Intensified diagnostic and therapeutic strategies for post-SOT infections are warranted based on these findings.
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