Invasive fungal infections following renal transplantation: a review of 2410 recipients.
BACKGROUND
Organ transplant recipients, on long-term graft preserving immunosuppressive therapy, are at increased risk for life threatening opportunistic fungal infections.


METHODS
In order to evaluate the incidence of invasive fungal infections (IFIs) and to identify the most common fungal pathogens, we conducted a retrospective study on 2410 ESRD cases undergone living kidney transplantation in three transplant centers between 1998 and 2008.


RESULTS
IFIs developed in 21 recipients (0.87%), 17 male and 4 female. Their immunosuppression was cyclosporine based. The mean age of patients was 48+/-10 (ranged from 32 to 67) years. Diagnosis was made by radiological findings, positive blood or bronchoalveolar lavage (BAL) cultures and tissue biopsies. Mucormycosis was the most common cause of IFIs in population studied (n=11), followed by disseminated candidiasis (n=4), aspergillosis (n=3), nocardiasis (n=2) and histoplasmosis (n=1). Pulmonary involvement was dominant (47.6%). The treatment was successful in only 10 patients and the rest died.


CONCLUSIONS
In our large series of kidney transplant recipients, mucormycosis was found to be the most common cause of invasive fungal infection. Prompt diagnosis and treatment are necessary to avoid the life threatening complications and may greatly improve prognosis.
Einollahi
Behzad
B
Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. behzad.einollahi@gmail.com
Lessan-Pezeshki
Mahboob
M
Pourfarziani
Vahid
V
Nemati
Eghlim
E
Nafar
Mohsen
M
Pour-Reza-Gholi
Fatemeh
F
Hassan Ghadyani
Mohammad
M
Samadian
Fariba
F
Ahmadpoor
Pedram
P
Aslani
Jafar
J
D000328:Adult; D000368:Aged; D001228:Aspergillosis / Q000453:epidemiology; D001706:Biopsy; D002177:Candidiasis / Q000453:epidemiology; D005260:Female; D006660:Histoplasmosis / Q000453:epidemiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000473:pathology; D008171:Lung Diseases / Q000453:epidemiology / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000453:epidemiology; D009181:Mycoses / Q000453:epidemiology* / Q000401:mortality; D009617:Nocardia Infections / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors