We created a database of solid organ transplant (SOT) recipients using innovative data mining tools. This study describing the epidemiology of invasive fungal disease (IFD) in heart transplant (HT) recipients serves as a proof of concept of such techniques in clinical research.

Methods: This is a retrospective single center cohort study. Data mining tools were used to extract data from the electronic medical record and merged it with information from the SRTR. Recipients of their first HT from 2010-2016 were included. Medical records of subjects with positive cultures, fungal serologies, histopathology and autopsies were manually adjudicated using MSG/EOCRT criteria. The 1-year cumulative incidence was calculated using the Kaplan-Meier method. Cox models were used to identify risk factors for IFD and 1-year mortality. CMV, neutropenia, rejection, post-transplant ECMO and renal replacement therapy (RRT) were analyzed as time dependent covariates in the IFD model.

Results: 204 HT recipients met inclusion criteria, 19 developed an IFD. The cumulative incidence was 9.5% at 1 year, and median time to onset 52 days (7-344). The most common pathogens were: Aspergillus sp. (31.6%), Candida sp. (31.6%), H. capsulatum (10.6%), Mucormycosis (10.6%). The most common sources of IFD were: lower respiratory tract infection (36.8%), surgical site infection (21.1%), disseminated disease (15.8%), and central line associated bloodstream infection (10.5%). In multivariable analysis, the risk of IFD was associated with post-transplant ECMO (p=0.049, HR=8.8), and RRT (p=0.01, HR=8.8). The 12-week mortality was 37% (7/19) and 64% (7/11) after the first IFD and invasive mold infection, respectively. In multivariable analysis, the risk of 1-year mortality was associated with IFD (p=0.0003, HR=9.0).

Conclusions: Post-transplant ECMO, and RRT were associated with an increased risk of acquisition of an IFD in HT. Furthermore, this study illustrates the potential of data mining tools to study infectious complications in solid organ transplant recipients.

CITATION INFORMATION: Barros N., Xie D., Yek C., Liu T., Li X., Adams-Huet B., Martinez J., Garg S., Grodin J., Morelend R., Amin A., Aras F., Thibodeau J., Mammen P., Peltz M., Drazner M., Ring W., Haley R., La Hoz R. Solid Organ Transplantation and Data Mining: Risk Factors for Invasive Fungal Disease in Heart Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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