Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET).
BACKGROUND
Invasive fungal infections (IFIs) are a major cause of morbidity and mortality among organ transplant recipients. Multicenter prospective surveillance data to determine disease burden and secular trends are lacking.


METHODS
The Transplant-Associated Infection Surveillance Network (TRANSNET) is a consortium of 23 US transplant centers, including 15 that contributed to the organ transplant recipient dataset. We prospectively identified IFIs among organ transplant recipients from March, 2001 through March, 2006 at these sites. To explore trends, we calculated the 12-month cumulative incidence among 9 sequential cohorts.


RESULTS
During the surveillance period, 1208 IFIs were identified among 1063 organ transplant recipients. The most common IFIs were invasive candidiasis (53%), invasive aspergillosis (19%), cryptococcosis (8%), non-Aspergillus molds (8%), endemic fungi (5%), and zygomycosis (2%). Median time to onset of candidiasis, aspergillosis, and cryptococcosis was 103, 184, and 575 days, respectively. Among a cohort of 16,808 patients who underwent transplantation between March 2001 and September 2005 and were followed through March 2006, a total of 729 IFIs were reported among 633 persons. One-year cumulative incidences of the first IFI were 11.6%, 8.6%, 4.7%, 4.0%, 3.4%, and 1.3% for small bowel, lung, liver, heart, pancreas, and kidney transplant recipients, respectively. One-year incidence was highest for invasive candidiasis (1.95%) and aspergillosis (0.65%). Trend analysis showed a slight increase in cumulative incidence from 2002 to 2005.


CONCLUSIONS
We detected a slight increase in IFIs during the surveillance period. These data provide important insights into the timing and incidence of IFIs among organ transplant recipients, which can help to focus effective prevention and treatment strategies.
Pappas
Peter G
PG
Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham Medical Center, Birmingham, Alabama 35294-0006, USA. pappas@uab.edu
Alexander
Barbara D
BD
Andes
David R
DR
Hadley
Susan
S
Kauffman
Carol A
CA
Freifeld
Alison
A
Anaissie
Elias J
EJ
Brumble
Lisa M
LM
Herwaldt
Loreen
L
Ito
James
J
Kontoyiannis
Dimitrios P
DP
Lyon
G Marshall
GM
Marr
Kieren A
KA
Morrison
Vicki A
VA
Park
Benjamin J
BJ
Patterson
Thomas F
TF
Perl
Trish M
TM
Oster
Robert A
RA
Schuster
Mindy G
MG
Walker
Randall
R
Walsh
Thomas J
TJ
Wannemuehler
Kathleen A
KA
Chiller
Tom M
TM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology*; D011446:Prospective Studies; D018571:Sentinel Surveillance; D019737:Transplants / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology; D055815:Young Adult