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Updated: Oct 12, 2025
Murine Renal Transplantation Procedure
Published on: July 10, 2009
Incidence and risk factors for mucormycosis in renal transplant patients
Melissa Rachel Downey1, Varsha Taskar1, Daniel F Linder2
1Medicine, Medical College of Georgia, Augusta, Georgia, USA.
Background:
Renal transplant patients are at increased risk for mucormycosis. Diabetes, neutropenia, deferoxamine therapy, and immunosuppressive medications have been associated with increased risk of mucormycosis in studies of solid organ transplant recipients. To focus on renal transplant patients, the US Renal Data System (USRDS) was queried to determine the incidence and risk factors for mucormycosis.
Methods:
All renal transplant patients in the USRDS from 1988 to 2015 were queried for a diagnosis of mucormycosis after the first transplant date using ICD-9 and ICD-10 codes. The International Classification of Diseases (ICD) codes, which currently exist in the ninth and tenth revisions, are a global system of classification used to code diagnoses, procedures, and symptoms. We defined proven mucormycosis by a histopathologic or fungal stain procedure code within 7 days of the diagnosis code. Logistic regression controlling for person-years at risk was used to examine demographic and clinical diagnosis risk factors for mucormycosis.
Results:
Of the 306,482 renal transplant patients, 222 (0.07%) had codes consistent with proven mucormycosis. The incidence of mucormycosis increased from 1990 to 2000 (peak 17.6 per 100,000 person-years) and subsequently demonstrated more variability. Hispanic ethnicity (OR=1.45), age 65 years or greater (OR=1.64), other or black race compared with white race (OR=1.96 and 1.74), cadaver or other donor type (OR=2.41), and receiving tacrolimus (OR=2.09) were associated with increased risk. Comorbidities associated with decreased risk of mucormycosis included female sex (OR=0.68), iron overload (OR=0.56), and receiving mycophenolate mofetil (OR=0.67) or azathioprine (OR=0.53).
Conclusions:
In renal transplant patients, age, deceased donor graft transplant, tacrolimus administration, race other than white, and Hispanic ethnicity were associated with increased risk of mucormycosis. Unexpectedly, iron overload was protective. Mucormycosis is a rare infection in renal transplant patients which should be considered in patients with the above risk factors after more common infections have been ruled out.
Insights
Mucormycosis is a rare fungal infection in renal transplant patients. Increased risk is linked to older age, deceased donor transplants, tacrolimus use, non-white race, and Hispanic ethnicity.
Area of Science:
- Nephrology
- Infectious Diseases
- Epidemiology
Background:
- Renal transplant recipients face a higher risk of mucormycosis.
- Factors like diabetes, neutropenia, and immunosuppression are known risks in solid organ transplant recipients.
- This study specifically examines mucormycosis incidence and risk factors in renal transplant patients using the US Renal Data System (USRDS).
Purpose of the Study:
- To determine the incidence of mucormycosis in renal transplant patients.
- To identify demographic and clinical risk factors associated with mucormycosis in this population.
Main Methods:
- Data from 306,482 renal transplant patients in the USRDS (1988-2015) were analyzed.
- Mucormycosis diagnosis was identified using International Classification of Diseases (ICD-9/ICD-10) codes.
- Proven mucormycosis was defined by histopathologic or fungal stain codes within 7 days of diagnosis; logistic regression was used to assess risk factors.
Main Results:
- The incidence of mucormycosis was 0.07% (222 cases) and peaked between 1990-2000.
- Increased risk was associated with Hispanic ethnicity, age ≥65, non-white/black race, deceased donor transplants, and tacrolimus use.
- Female sex, iron overload, mycophenolate mofetil, and azathioprine were associated with decreased risk.
Conclusions:
- Age, deceased donor grafts, tacrolimus, non-white race, and Hispanic ethnicity increase mucormycosis risk in renal transplant patients.
- Iron overload unexpectedly showed a protective effect.
- Mucormycosis is rare but should be considered in renal transplant patients with these risk factors, especially after ruling out more common infections.
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