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Invasive Fungal Disease in Pediatric Solid Organ Transplant Recipients
Shikha Saxena1, Jerica Gee2, Sarah Klieger2
1Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Insights
Invasive fungal disease (IFD) occurred in 2.2% of pediatric solid organ transplant (SOT) recipients. Lung and heart/lung transplant patients faced the highest IFD risk, with a significant case-fatality rate, underscoring the need for targeted antifungal strategies.
Area of Science:
- Pediatric Transplant Medicine
- Infectious Diseases
- Immunocompromised Hosts
Background:
- Solid organ transplant (SOT) recipients face a significant risk of invasive fungal disease (IFD).
- Limited data exists on the burden and outcomes of IFD specifically in pediatric SOT populations.
- This study addresses the need for comprehensive data on IFD in children undergoing SOT.
Purpose of the Study:
- To determine the incidence of IFD in a large cohort of pediatric SOT recipients.
- To analyze the outcomes, including mortality, associated with IFD in this patient group.
- To identify specific transplant types with higher IFD risk.
Main Methods:
- Retrospective analysis of a single-center cohort of pediatric SOT patients (2000-2013).
- Follow-up for 180 days post-transplant or until death to assess IFD.
- IFD defined using established European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and National Institute of Allergy and Infectious Diseases Mycoses Study Group criteria (proven or probable).
Main Results:
- 14 episodes of IFD (candidiasis, aspergillosis, mucormycosis) occurred in 13 of 584 pediatric SOT recipients (overall incidence 2.2%).
- Highest IFD incidence observed in heart/lung (12.5%) and lung (11.4%) transplant recipients.
- A 21.4% case-fatality rate was observed for IFD, with deaths primarily attributed to IFD in lung and heart/lung recipients.
Conclusions:
- Pediatric SOT recipients have a low overall incidence of IFD, but risk varies significantly by transplant type.
- Lung and heart/lung transplant recipients are at a substantially higher risk for IFD.
- The high attributable case-fatality rate necessitates further research into targeted antifungal prophylaxis for high-risk pediatric SOT groups.
Background:
Solid organ transplant (SOT) recipients are at risk for invasive fungal disease (IFD). Data on IFD burden in pediatric patients are limited. We aimed to determine the incidence and outcome of IFD in a large cohort of pediatric patients who underwent SOT.
Methods:
A single-center cohort of pediatric patients who underwent SOT between 2000 and 2013 was assembled retrospectively. The patients were followed for 180 days after transplant or until death to determine the presence or absence of IFD. The 2008 European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group Consensus Group criteria were used to define IFD as proven or probable. The incidence of IFD, all-cause mortality rate, and case-fatality rate at 180 days were calculated.
Results:
Among 584 pediatric patients who underwent SOT, 13 patients sustained 14 episodes of IFD (candidiasis, aspergillosis, and mucormycosis). The overall incidence was 2.2% (14.3 IFD events per 100000 patient-days). The IFD rates according to transplant type were 12.5% (1 of 8) (heart/lung), 11.4% (4 of 35) (lung), 4.7% (8 of 172) (liver), 0% (0 of 234) (kidney), and 0% (0 of 135) (heart). Three patients with IFD (2 lung and 1 heart/lung) died, and all these deaths were deemed likely attributable to the IFD; the case-fatality rate was 21.4% (3 of 14).
Conclusions:
The overall incidence of IFD in these pediatric SOT recipients was low but varied across transplant type, with heart/lung and lung recipients having the highest IFD rate. Given the attributable case-fatality rate, the risk of death resulting from IFD is potentially high. More data on groups at higher risk, such as lung transplant recipients, are needed to guide targeted antifungal prophylaxis.