title: Zygomycosis in solid organ transplant recipients: a prospective, matched case-control study to assess risks for disease and outcome.
abstract: BACKGROUND
  Clinical characteristics, risks, and outcomes in solid organ transplant (SOT) recipients with zygomycosis in the era of modern immunosuppressive and newer antifungal agent use have not been defined.
  
  
  METHODS
  In a matched case-controlled study, SOT recipients with zygomycosis were prospectively studied. The primary outcome measure was success (complete or partial response) at 90 days.
  
  
  RESULTS
  Renal failure (odds ratio [OR], 3.17; P = .010), diabetes mellitus (OR, 8.11; P < .001), and prior voriconazole and/or caspofungin use (OR, 4.41; P = .033) were associated with a higher risk of zygomycosis, whereas tacrolimus (OR, 0.23; P = .002) was associated with a lower risk of zygomycosis. Liver transplant recipients were more likely to have disseminated disease (OR, 5.48; P = .021) and developed zygomycosis earlier after transplantation than did other SOT recipients (median, 0.8 vs 5.7 months; P < .001). Overall the treatment success rate was 60%. Renal failure (OR, 11.3; P = .023) and disseminated disease (OR, 14.6; P = .027) were independently predictive of treatment failure, whereas surgical resection was associated with treatment success (OR, 33.3; P = .003). The success rate with liposomal amphotericin B was 4-fold higher even when controlling for the aforementioned variables.
  
  
  CONCLUSIONS
  The risks identified for zygomycosis and for disseminated disease, including those that were previously unrecognized, have implications for further elucidating the biologic basis and for optimizing outcomes in SOT recipients with zygomycosis.
authors: Infectious Diseases Section, VA Medical Center, University Drive., Pittsburgh, PA 15240, USA. nis5@pitt.edu
authors: Nina
authors: N
authors: Singh
authors: Jose M
authors: JM
authors: Aguado
authors: Hugo
authors: H
authors: Bonatti
authors: Graeme
authors: G
authors: Forrest
authors: Krishan L
authors: KL
authors: Gupta
authors: Nasia
authors: N
authors: Safdar
authors: George T
authors: GT
authors: John
authors: Kenneth J
authors: KJ
authors: Pursell
authors: Patricia
authors: P
authors: Muñoz
authors: Robin
authors: R
authors: Patel
authors: Jesus
authors: J
authors: Fortun
authors: Pilar
authors: P
authors: Martin-Davila
authors: Bruno
authors: B
authors: Philippe
authors: François
authors: F
authors: Philit
authors: Alexis
authors: A
authors: Tabah
authors: Nicolas
authors: N
authors: Terzi
authors: Valérie
authors: V
authors: Chatelet
authors: Shimon
authors: S
authors: Kusne
authors: Nina
authors: N
authors: Clark
authors: Emily
authors: E
authors: Blumberg
authors: Marino Blanes
authors: MB
authors: Julia
authors: Abhi
authors: A
authors: Humar
authors: Sally
authors: S
authors: Houston
authors: Cornelia
authors: C
authors: Lass-Flörl
authors: Leonard
authors: L
authors: Johnson
authors: Erik R
authors: ER
authors: Dubberke
authors: Michelle A
authors: MA
authors: Barron
authors: Olivier
authors: O
authors: Lortholary
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications / Q000382:microbiology; D011446:Prospective Studies; D012307:Risk Factors; D020096:Zygomycosis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control
chemical_list: D000935:Antifungal Agents; D007166:Immunosuppressive Agents