The Feared Five Fungal Infections in Kidney Transplant Recipients: 20-Year Experience at a Midwestern Center.
University of Wisconsin, Madison, WI
Meeting: 2017 American Transplant Congress
Abstract number: A178
Keywords: Fungal infection, Graft survival, Immunosuppression, Kidney transplantation
Session Information
Session Name: Poster Session A: Kidney Complications I
Session Type: Poster Session
Date: Saturday, April 29, 2017
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall D1
Invasive fungal infections (IFI) are increasing in kidney transplant recipients (KTR). Here we present our experience with five feared IFIs in KTR transplanted between 01/01/1994 and 06/30/2014: aspergillus (Asper), cryptococcus (Crypto), histoplasmosis (Histo), blastomycosis (Blasto), and coccidioidomycosis (Cocci). There were a total of 128 cases of fungal infections, with Asper being the most common (72), followed by Crypto (29), Histo (14), Blasto (10) and Cocci (3). The mean age at time of transplant was 53.65 ±12.56 years, 66.4% were male, 85.9% were Caucasian. The mean interval from transplant to fungal infection was 3.19 ± 3.58 years (range 5 days-15.8 years). By six months post-infection, there were 53 (41%) graft losses and 24 (19%) deaths. These included 33 graft losses with Asper (including 14 deaths); 11 in crypto (including 6 deaths); 4 in Blasto (including 3 deaths),3 in Histo (including 1 death) and 2 in Cocci (no deaths). The median graft survival post-infection for Cocci, Asper,Crypto, Blasto, and Histo were 2,181,224, 321, and 623 days respectively. Thymoglobulin induction, diabetes and age were associated with increased risk for infection in univariate analysis, while living donor was associated with decreased risk. Thymoglobulin induction and higher age were associated with increased risk after adjustment for different variables.
| Factors Associated with fungal infections | ||||||
| Variable | Univariate Analysis | Multivariate Analysis | ||||
| HR | 95% CI | P | HR | 95% CI | P | |
| Nonwhite | 1.06 | 0.64, 1.74 | 0.83 | 1.16 | 0.70, 1.93 | 0.56 |
| Female | 0.73 | 0.50, 1.05 | 0.09 | 0.72 | 0.50, 1.04 | 0.08 |
| Thymoglobulin Induction | 1.49 | 1.03, 2.16 | 0.04 | 1.52 | 1.04, 2.22 | 0.03 |
| Re-transplant | 1.26 | 0.84, 1.88 | 0.27 | 1.51 | 0.99, 2.30 | 0.06 |
| Diabetes | 1.53 | 1.05, 2.21 | 0.03 | 1.30 | 0.89, 1.88 | 0.17 |
| Age (/per 10 years) | 1.47 | 1.27, 1.70 | <0.001 | 1.51 | 1.29, 1.77 | <0.001 |
| Living Donor transplant | 0.69 | 0.48, 1.00 | 0.05 | 0.84 | 0.58, 1.21 | 0.34 |
IFIs have a poor prognosis, with high rates of graft failure and mortality in KTR. More recent advances in the management of IFIs, including the use of oral azoles, may improve outcomes.
CITATION INFORMATION: Parajuli S, Wick A, Pandeya S, Astor B, Smith J, Djamali A, Mandelbrot D. The Feared Five Fungal Infections in Kidney Transplant Recipients: 20-Year Experience at a Midwestern Center. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Parajuli S, Wick A, Pandeya S, Astor B, Smith J, Djamali A, Mandelbrot D. The Feared Five Fungal Infections in Kidney Transplant Recipients: 20-Year Experience at a Midwestern Center. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/the-feared-five-fungal-infections-in-kidney-transplant-recipients-20-year-experience-at-a-midwestern-center/. Accessed November 22, 2024.« Back to 2017 American Transplant Congress