title: Trends in invasive disease due to Candida species  following heart and lung transplantation.
abstract: Although invasive candidiasis (IC) causes significant morbidity and mortality in patients who undergo heart, lung, or heart-lung transplantation, a systematic study in a large cohort of thoracic organ transplant recipients has not been reported to date. Clinical and microbiological data were reviewed for 1305 patients who underwent thoracic organ transplantation at Stanford University Medical Center between 1980 and 2004. We identified and analyzed 76 episodes of IC in 68 patients (overall incidence 5.2% per patient).The incidence of IC was higher in lung (LTx) and heart-lung transplant (HLTx) recipients as compared with heart transplant (HTx) recipients (risk ratio [RR] 1.7, 95% confidence interval [CI] 1.1-2.7).The incidence of IC decreased over time in all thoracic organ transplant recipients, decreasing from 6.1% in the 1980-1986 time period to 2.1% in the 2001-2004 era in the HTx recipients, and from 20% in the 1980-1986 period to 1.8% in the 2001-2004 period in the LTx and HLTx recipients.The most common site of infection differed between the HTx and LTx cohorts, with bloodstream or disseminated disease in the former and tracheobronchitis in the latter. IC in the first year after transplant was significantly associated with death in both HTx (RR 2.9, 95% CI 1.8-4.6, P=0.001) and LTx and HLTx patients (RR 3.0, 95% CI 1.9-4.6, P<0.001). The attributable mortality from IC decreased during the 25-year period of observation, from 36% to 20% in the HTx recipients and from 39% to 15% in the LTx and HLTx recipients. There were a significant number of cases caused by non-albicans Candida species in all patients, with a trend toward higher mortality in the HTx group. In conclusion, the incidence and attributable mortality of IC in thoracic organ transplant recipients has significantly declined over the past 25 years.The use of newer antifungal agents for prophylaxis and treatment, the decrease in the incidence of cytomegalovirus disease, and the use of more selective immunosuppression, among other factors, may have been responsible for this change.
authors.affiliation: Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California 94305, USA. joannas@stanford.edu
authors.forename: J M
authors.initials: JM
authors.lastname: Schaenman
authors.forename: F
authors.initials: F
authors.lastname: Rosso
authors.forename: J M
authors.initials: JM
authors.lastname: Austin
authors.forename: E J
authors.initials: EJ
authors.lastname: Baron
authors.forename: P
authors.initials: P
authors.lastname: Gamberg
authors.forename: J
authors.initials: J
authors.lastname: Miller
authors.forename: P E
authors.initials: PE
authors.lastname: Oyer
authors.forename: R C
authors.initials: RC
authors.lastname: Robbins
authors.forename: J G
authors.initials: JG
authors.lastname: Montoya
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D002140:California / Q000453:epidemiology; D002175:Candida / Q000145:classification / Q000302:isolation & purification; D002177:Candidiasis / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D016041:Heart-Lung Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D007166:Immunosuppressive Agents