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Published on: April 13, 2021
Fungal Infections in Kidney Transplant Recipients: A Comprehensive Narrative Review
Maria Mazzitelli1, Federico Nalesso2, Alberto Enrico Maraolo3
1Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy.
Background:
Despite kidney transplantation being a life-saving procedure, patients experience a high risk of developing fungal infections (FIs), with an increased risk of both morbidity and mortality, especially during the first year after transplant.
Methods:
We herein conducted a narrative review of the most common FIs in kidney transplant recipients (KTRs), with a focus on prevalence, risk factors, mortality, and prevention strategies.
Results:
The most common fungal pathogens in KTRs include Candida species (up to 70% of the overall FIs), Aspergillus species, Pneumocystis jiroveci, and Cryptococcus species. Fungal colonization, diabetes mellitus, chronic liver disease, malnutrition, and pre-existing lung conditions should all be acknowledged as possible predisposing risk factors. The mortality rate can vary from 25 to 50% and according to different settings and the types of FIs. Preventive strategies are critical for reducing the incidence of FIs in this population. These include antifungal prophylaxis, environmental precautions, and infection control measures. The use of novel tools (such as PCR-based molecular assays and NGS) for rapid and accurate diagnosis may play an important role.
Conclusions:
Early recognition, the appropriate use of antifungal therapy, and preventive strategies are essential for improving graft loss and fatal outcomes in this vulnerable population. Future research is needed to optimize diagnostic tools, identify novel antifungal agents, and develop better prophylactic strategies for high-risk transplant recipients.
Insights
Kidney transplant recipients face high risks of fungal infections (FIs), leading to increased morbidity and mortality. Early recognition, antifungal therapy, and prevention are crucial for better outcomes in these patients.
Area of Science:
- Nephrology
- Infectious Diseases
- Transplantation Immunology
Background:
- Kidney transplantation is life-saving but carries a high risk of fungal infections (FIs).
- Fungal infections significantly increase morbidity and mortality, particularly within the first year post-transplant.
Purpose of the Study:
- To review common fungal infections in kidney transplant recipients (KTRs).
- To focus on the prevalence, risk factors, mortality, and prevention strategies for FIs in KTRs.
Main Methods:
- A narrative review was conducted.
- The review focused on common FIs in kidney transplant recipients.
Main Results:
- Candida species are the most common pathogens (up to 70%), followed by Aspergillus, Pneumocystis jiroveci, and Cryptococcus.
- Risk factors include fungal colonization, diabetes, liver disease, malnutrition, and lung conditions. Mortality rates range from 25-50%.
- Preventive strategies like antifungal prophylaxis, environmental controls, and infection measures are critical. Novel diagnostic tools (PCR, NGS) show promise.
Conclusions:
- Early recognition and appropriate antifungal therapy are essential for improving outcomes and reducing mortality.
- Preventive strategies are vital for managing FIs in this vulnerable population.
- Future research should focus on optimizing diagnostics, developing new antifungal agents, and enhancing prophylactic strategies.
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