title: Caspofungin in the treatment of azole-refractory esophageal candidiasis in kidney transplant recipients.
abstract: BACKGROUND
  Infection is a common cause of morbidity and mortality in kidney transplant recipients. The incidence of esophageal and urogenital candidiasis in kidney and kidney-pancreas transplant recipients has not been well documented. Azoles are safe, effective agents to treat esophageal candidiasis. However, resistance to azoles is now becoming common. This study reports the use of caspofungin for the treatment of azole-resistant esophageal and urogenital candidiasis in kidney transplant recipients.
  
  
  METHODS
  The incidence of esophageal and urogenital candidiasis was evaluated among 140 kidney transplantations and four combined kidney-pancreas transplants performed over a 2-year period.
  
  
  RESULTS
  Twenty-two patients (15.7%) presented with esophageal candidiasis, while seven patients (5%) showed urogenital candidiasis. Thirteen patients with esophageal candidiasis (59%) and four patients (57%) with urogenital candidiasis did not improve after a week of azole treatment. A regimen of caspofungin was started in these patients, who tolerated the treatment. Urogenital candidiasis recurred in two patients 2 and 3 months after the treatment. One patient with esophageal candidiasis did not improve with caspofungin and was switched to amphotericin B therapy. There were no other recurrences of candidiasis among patients treated with caspofungin for a median follow-up of 8 months.
  
  
  CONCLUSIONS
  Renal transplant patients remain at high risk for fungal infections. Although the number of patients was limited, the results of this study indicated that caspofungin is an effective, well-tolerated alternative for difficult-to-treat, azole-resistant candida infections in kidney and pancreas transplant recipients. The high costs of the drug limit the use of caspofungin as first-line antifungal therapy, reserving its use to recipients who had undergone unsuccessful azole therapy.
authors.affiliation: Department of Surgery, Transplantation and Advanced Technologies, Organ Transplant Unit, University Hospital of Catania, Italy. veroux@unict.it
authors.forename: M
authors.initials: M
authors.lastname: Veroux
authors.forename: M
authors.initials: M
authors.lastname: Macarone
authors.forename: P
authors.initials: P
authors.lastname: Fiamingo
authors.forename: D
authors.initials: D
authors.lastname: Cappello
authors.forename: M
authors.initials: M
authors.lastname: Gagliano
authors.forename: M
authors.initials: M
authors.lastname: Di Mare
authors.forename: D
authors.initials: D
authors.lastname: Vizcarra
authors.forename: M
authors.initials: M
authors.lastname: Spataro
authors.forename: G
authors.initials: G
authors.lastname: Giuffrida
authors.forename: M
authors.initials: M
authors.lastname: Sorbello
authors.forename: V
authors.initials: V
authors.lastname: Severino
authors.forename: P
authors.initials: P
authors.lastname: Veroux
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D002177:Candidiasis / Q000188:drug therapy* / Q000453:epidemiology; D002181:Candidiasis, Vulvovaginal / Q000188:drug therapy / Q000453:epidemiology; D000077336:Caspofungin; D016572:Cyclosporine / Q000009:adverse effects; D054714:Echinocandins; D004935:Esophageal Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D055666:Lipopeptides; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy; D012189:Retrospective Studies; D016559:Tacrolimus / Q000009:adverse effects; D013997:Time Factors
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D007166:Immunosuppressive Agents; D055666:Lipopeptides; D010456:Peptides, Cyclic; D016572:Cyclosporine; D015725:Fluconazole; D000077336:Caspofungin; D016559:Tacrolimus