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Invasive Fungal Diseases in Kidney Transplant Recipients: Risk Factors for Mortality
Hyeri Seok1,2, Kyungmin Huh1, Sun Young Cho1
1Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
Background:
Invasive fungal disease (IFD) is common in solid organ transplant (SOT) recipients and contributes to high morbidity and mortality. Although kidney transplantation (KT) is a commonly performed SOT, data on the risk factors for IFD-related mortality are limited.
Methods:
A 1:2 retrospective case-control study was performed in an experienced single center in the Republic of Korea. We reviewed the electronic medical records of patients with IFD after KT between February 1995 and March 2015.
Results:
Of 1963 kidney transplant recipients, 48 (2.5%) were diagnosed with IFD. The median interval from KT to IFD diagnosis was 172 days. Invasive aspergillosis (IA) was the most common, followed by invasive candidiasis (IC). Diabetes mellitus (DM) (odds ratio (OR) 3.72, 95% confidence interval (CI) 1.34-10.31, p = 0.011) and acute rejection (OR 3.41, 95% CI 1.41-8.21, p = 0.006) were associated with IFD development. In the subgroup analyses, concomitant bacterial infection was associated with IC development (OR 20.10, 95% CI 3.60-112.08, p = 0.001), and delayed graft function was associated with IA occurrence (OR 10.60, 95% CI 1.05-106.84, p = 0.045). The 12-week mortality rate in all patients was 50.0%. Mortality rates were significantly higher in older patients (adjusted hazard ratio (aHR) 1.06, 95% CI 1.02-1.11, p = 0.004), or those with DM (aHR 2.61, 95% CI 1.02-6.68, p = 0.044), deceased donor transplantation (aHR 2.68, 95% CI 1.03-6.95, p = 0.043), lymphocyte-depleting antibody usage (aHR 0.26, 95% CI 0.08-0.80, p = 0.019), acute rejection (aHR 0.38, 95% CI 0.15-0.97, p = 0.044), and concomitant bacterial infection (aHR 8.76, 95% CI 1.62-47.51, p = 0.012).
Conclusions:
A total of 50% of IFD cases occurred six months or later after transplantation. The IFD-related mortality rate was high in kidney transplant recipients despite the low incidence. DM and acute rejection were associated with high mortality, as well as IFD development. As old age, deceased donor transplantation, lymphocyte-depleting antibody usage, and concomitant bacterial infection are risk factors for IFD-related mortality, efforts for its early diagnosis and appropriate treatment are required.
Insights
Invasive fungal disease (IFD) affects 2.5% of kidney transplant recipients, with a 50% mortality rate. Key risk factors for IFD and death include diabetes mellitus and acute rejection.
Area of Science:
- Nephrology
- Transplant Surgery
- Infectious Diseases
Background:
- Invasive fungal disease (IFD) is a significant cause of morbidity and mortality in solid organ transplant (SOT) recipients.
- Data on specific risk factors for IFD-related mortality in kidney transplant (KT) recipients remain limited.
Purpose of the Study:
- To investigate the incidence, risk factors, and mortality associated with IFD in kidney transplant recipients.
- To identify specific patient characteristics and treatment-related factors influencing IFD development and outcomes.
Main Methods:
- A retrospective case-control study involving 1963 KT recipients over a 20-year period (February 1995 to March 2015).
- Analysis of electronic medical records to identify IFD cases and associated risk factors for development and mortality.
Main Results:
- IFD occurred in 2.5% of KT recipients, with a median diagnosis interval of 172 days post-transplant.
- Diabetes mellitus (DM) and acute rejection were significantly associated with IFD development.
- Mortality was high (50% at 12 weeks), with older age, DM, deceased donor transplantation, lymphocyte-depleting antibody use, acute rejection, and concomitant bacterial infection identified as mortality risk factors.
Conclusions:
- IFD poses a substantial mortality risk in KT recipients, even with a low incidence.
- DM and acute rejection are critical factors for both IFD development and mortality.
- Early diagnosis and prompt treatment are crucial, considering risk factors such as older age, deceased donor status, and bacterial co-infections.
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