Zygomycosis in solid organ transplant recipients: a prospective, matched case-control study to assess risks for disease and outcome.
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.
Singh
Nina
N
Infectious Diseases Section, VA Medical Center, University Drive., Pittsburgh, PA 15240, USA. nis5@pitt.edu
Aguado
Jose M
JM
Bonatti
Hugo
H
Forrest
Graeme
G
Gupta
Krishan L
KL
Safdar
Nasia
N
John
George T
GT
Pursell
Kenneth J
KJ
Muñoz
Patricia
P
Patel
Robin
R
Fortun
Jesus
J
Martin-Davila
Pilar
P
Philippe
Bruno
B
Philit
François
F
Tabah
Alexis
A
Terzi
Nicolas
N
Chatelet
Valérie
V
Kusne
Shimon
S
Clark
Nina
N
Blumberg
Emily
E
Julia
Marino Blanes
MB
Humar
Abhi
A
Houston
Sally
S
Lass-Flörl
Cornelia
C
Johnson
Leonard
L
Dubberke
Erik R
ER
Barron
Michelle A
MA
Lortholary
Olivier
O
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
D000935:Antifungal Agents; D007166:Immunosuppressive Agents