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Fungal infections common among organ transplant patients
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SAN FRANCISCO — Fungal infections occurred in 9% of transplant recipients, mostly within 6 months after transplantation, recent data suggest.
The data, presented at the 52nd Interscience Conference on Antimicrobial Agents and Chemotherapy, come from a prospective observational study that included all patients included in the Swiss Transplant Cohort Study from May 2008 to November 2011.
Christian van Delden, MD, of the University Hospital of Geneva, and colleagues included 1,053 patients who had at least 6 months of follow-up in the study. They identified 96 patients who had 125 fungal infections. The most fungal infections occurred in patients with kidney transplants — 68 infections. Among liver transplants, there were 25 infections; heart transplants, 17 infections; lung transplants, 13 infections; and kidney-pancreas transplants, two infections.
Forty-three of the fungal infections were mucocutaneous, and 35 occurred on the respiratory tract. For patients who received kidney transplants, the median time after transplantation to the occurrence of the fungal infection was 3.4 months. For heart transplants, the median time was 1.6 months, and for liver transplants, the median time was 1 month. For lung transplants, the median time was 1.9 months.
The most common infection was Candida albicans, which affected 28 kidney transplant patients, 17 liver transplant patients, six lung cancer patients and four heart transplant patients. Aspergillus fumigatus affected nine kidney transplant patients, four lung cancer patients, two heart transplant patients and one of each liver transplant and kidney-pancreas transplant patients.
Most of the patients with fungal infection (93%) were treated, and in 105 of the cases, a single antifungal treatment was used. Among the patients with a fungal infection, 27% died. In comparison, 8% of patients with a different type of infection died.
For more information:
Lecompte T. #T-343. Presented at: 52nd ICAAC; Sept. 9-12, 2012; San Francisco.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Peter Chin-Hong, MD
Invasive fungal infections (IFI) are a substantial cause of morbidity and mortality following solid organ transplantation and varies based on the type of organ being transplanted. In a large U.S. cohort (TRANSNET) of 1208 IFIs, investigators reported a 1-year cumulative incidence post-transplant that ranged from 12% in small bowel transplant recipients to 1% in kidney transplant recipients. Mortality was also striking, from 30 to 40% depending on the species and the specific organ affected. Geographical location is also an important determinant of IFI epidemiology, not only because of differences in endemic mycoses, but also in varying strategies used by transplant centers to prevent IFI. Van Delden and others now report a similarly high mortality from a smaller cohort (125 IFIs) but geographically distinct location in Switzerland. Compared to the U.S. TRANSNET experience, the Swiss results highlight some differences with a shorter time to first IFI (range 1-3.5 months) alluding to possible differences in prophylactic regimens used, as well as some differences in the relative distribution of IFI seen. Taken together, studies like TRANSNET and the data presented by the Swiss Transplant Cohort Study investigators give good information on the variation in IFI risk based on geographical location. Given the difficulty and expense in conducting large randomized controlled studies, these cohorts may also give important insights on the optimal duration and agents that can be used for chemoprophylaxis.
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