Incidence and treatment of candida esophagitis in patients undergoing renal transplantation. Data from the Minnesota prospective randomized trial of cyclosporine versus antilymphocyte globulin-azathioprine.
Of 224 consecutive renal transplant patients in a prospective, randomized immunosuppressive trial, candida esophagitis developed in 5 despite nystatin prophylaxis. No differences were noted between cyclosporine and antilymphocyte globulin-azathioprine immunosuppressive treatment. All patients were diabetic, and four were recipients of cadaver kidneys. Candida esophagitis occurred within 6 months after transplantation, and only one patient had recurrence. All patients responded to treatment consisting of 2 to 6 days of intravenous amphotericin B (0.2 to 2 mg/kg total dose). The prevalence of candida esophagitis was not related to rejection episodes. Three of five patients eventually died, one 2 weeks after resolution of candida esophagitis from a hypoglycemic episode, one from acute exacerbation of pulmonary failure and relapsing pancreatitis in association with candida esophagitis and therapy-resistant candidemia, and one 17 months after candida esophagitis from pulmonary edema. Our findings show that candida esophagitis by itself is an easily managed complication, but is also a sign of potentially increased morbidity in these patients.
Frick
T
T
Department of Surgery, University of Minnesota Hospitals, Minneapolis 55455.
Fryd
D S
DS
Goodale
R L
RL
Simmons
R L
RL
Sutherland
D E
DE
Najarian
J S
JS
D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D001379:Azathioprine / Q000627:therapeutic use*; D002177:Candidiasis / Q000188:drug therapy / Q000453:epidemiology*; D002986:Clinical Trials as Topic; D003524:Cyclosporins / Q000627:therapeutic use*; D004941:Esophagitis / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008910:Minnesota; D009761:Nystatin / Q000627:therapeutic use; D011446:Prospective Studies; D011897:Random Allocation
D000961:Antilymphocyte Serum; D003524:Cyclosporins; D009761:Nystatin; D000666:Amphotericin B; D001379:Azathioprine