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Epidemiology and Risk Factors for Invasive Fungal Infections in Pancreas Transplant in the Absence of Postoperative
Jessica Zachary1, Jeanne M Chen1, Asif Sharfuddin2
1Department of Pharmacy, Indiana University Health, Indianapolis, Indiana, USA.
Background:
Invasive fungal infections (IFIs) remain a rare yet dreaded complication following pancreas transplantation. Current guidelines recommend antifungal prophylaxis in patients with 1 or more risk factors. At our center, single-dose antifungal prophylaxis is administered in the operating room but none subsequently, regardless of risk factors. Here we evaluate the 1-year incidence, outcome, and risk factors associated with IFI following pancreas transplantation.
Methods:
A retrospective, single-center cohort study was conducted in patients who underwent pancreas transplantation between 1 January 2009 and 31 December 2019. Records were manually reviewed, and cases were adjudicated using consensus definitions. The 1-year cumulative incidence, mortality, and risk factors were analyzed by Kaplan-Meier method and differences between populations were assessed with Fisher test and Mann-Whitney U test.
Results:
Three hundred sixty-nine recipients were included. Twelve IFIs were identified: candidiasis (8), aspergillosis (2), histoplasmosis (1), and cryptococcosis (1). Intra-abdominal infections were the most common presentation (5), followed by bloodstream infections (3), disseminated disease (2), pulmonary disease (1), and invasive fungal sinusitis (1). Median time to IFI was 64 days (interquartile range, 30-234 days). One-year cumulative incidence was 3.25% (95% confidence interval, 1.86%-5.65%). There were no significant differences between patients with or without IFI regarding type of transplant (P = .17), posttransplant dialysis (P = .3), rejection (P = .5), cytomegalovirus serostatus (P = .45), or reoperation (P = .19). For patients with IFI, the 1-year graft and patient survival rates were 58% versus 95% (P < .0001) and 75% versus 98.6% (P < .001), respectively.
Conclusions:
Our study suggests that the use of a single-dose antifungal prophylaxis administered in the operating room but none subsequently does not result in an increased incidence of IFI following pancreas transplantation.
Insights
A single intraoperative antifungal dose is sufficient for pancreas transplant recipients, showing no increased risk of invasive fungal infections (IFIs). This study evaluated IFI incidence and outcomes in these patients.
Area of Science:
- Transplantation immunology and infectious diseases.
- Clinical outcomes research in solid organ transplantation.
Background:
- Invasive fungal infections (IFIs) are a rare but serious complication post-pancreas transplantation.
- Current guidelines advocate for antifungal prophylaxis based on patient risk factors.
- This center utilizes a single intraoperative antifungal dose without subsequent prophylaxis.
Purpose of the Study:
- To assess the 1-year incidence of IFIs following pancreas transplantation.
- To identify outcomes and risk factors associated with IFIs in this patient population.
- To evaluate the efficacy of the center's current prophylaxis strategy.
Main Methods:
- Retrospective cohort study of 369 pancreas transplant recipients (2009-2019).
- Manual record review and case adjudication using consensus definitions.
- Analysis of 1-year cumulative incidence, mortality, and risk factors using Kaplan-Meier and appropriate statistical tests.
Main Results:
- Twelve IFIs occurred (3.25% cumulative incidence), including candidiasis, aspergillosis, histoplasmosis, and cryptococcosis.
- Intra-abdominal infections were most common; median time to IFI was 64 days.
- Patients with IFIs had significantly lower 1-year graft (58% vs 95%) and patient survival (75% vs 98.6%) rates.
Conclusions:
- A single intraoperative antifungal dose appears adequate, not leading to increased IFI incidence post-pancreas transplant.
- IFIs are associated with significantly poorer graft and patient survival.
- Further investigation into risk stratification and optimal prophylaxis may be warranted.
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