title: Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET).
abstract: 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.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham Medical Center, Birmingham, Alabama 35294-0006, USA. pappas@uab.edu
authors.forename: Peter G
authors.initials: PG
authors.lastname: Pappas
authors.forename: Barbara D
authors.initials: BD
authors.lastname: Alexander
authors.forename: David R
authors.initials: DR
authors.lastname: Andes
authors.forename: Susan
authors.initials: S
authors.lastname: Hadley
authors.forename: Carol A
authors.initials: CA
authors.lastname: Kauffman
authors.forename: Alison
authors.initials: A
authors.lastname: Freifeld
authors.forename: Elias J
authors.initials: EJ
authors.lastname: Anaissie
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Brumble
authors.forename: Loreen
authors.initials: L
authors.lastname: Herwaldt
authors.forename: James
authors.initials: J
authors.lastname: Ito
authors.forename: Dimitrios P
authors.initials: DP
authors.lastname: Kontoyiannis
authors.forename: G Marshall
authors.initials: GM
authors.lastname: Lyon
authors.forename: Kieren A
authors.initials: KA
authors.lastname: Marr
authors.forename: Vicki A
authors.initials: VA
authors.lastname: Morrison
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Park
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Patterson
authors.forename: Trish M
authors.initials: TM
authors.lastname: Perl
authors.forename: Robert A
authors.initials: RA
authors.lastname: Oster
authors.forename: Mindy G
authors.initials: MG
authors.lastname: Schuster
authors.forename: Randall
authors.initials: R
authors.lastname: Walker
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walsh
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Wannemuehler
authors.forename: Tom M
authors.initials: TM
authors.lastname: Chiller
mesh_terms: 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