title: Invasive Fungal Infections After Kidney Transplantation: A Single-center Experience.
abstract: BACKGROUND
  Invasive fungal infections (IFI) affecting transplant recipients are associated with increased mortality and graft dysfunction.
  
  
  OBJECTIVE
  Describe the frequency, clinical features, and outcomes of IFI (except pneumocystis infection) in kidney transplant recipients.
  
  
  METHODS
  Single-center descriptive study including every kidney transplant recipient with a culture-proven or probable IFI between 2003 and 2013, according to the EORTC-MSG criteria.
  
  
  RESULTS
  We identified 45 IFI. There were 13 cases of invasive candidiasis (C. albicans: 6 and non-C. albicans candidial spp.: 7), 11 cases of pulmonary aspergillosis (A. fumigatus: 9 and A. flavus: 2); 11 cases of subcutaneous mycosis (Alternaria spp.: 9, Paecilomyces spp.: 1, and Pseudallescheria spp.: 1); 7 cases of cryptococcosis; 2 cases of pneumonia by non-Aspergillus molds (Mucor spp.: 1 and Cunninghamella spp.: 1); and 1 case of Geotrichum capitatum pneumonia. All patients were recipients from deceased donors. Six cases occurred in the first 3 months post-transplant, 15 cases between the third and twelfth months, and 21 cases after the twelfth month. Treatment options were fluconazole for Candida infections, voriconazole or caspofungin for aspergillosis, liposomal amphotericin for cryptococcosis, and itraconazole plus excision or cryotherapy for subcutaneous mycosis. Fifteen patients died (33%). Mortality rates were 15% for invasive candidiasis, 45% for aspergillosis, 71% for cryptococcosis, 100% for non-Aspergillus molds and G. capitatum pneumonia, and 0% for subcutaneous mycosis. Six patients who survived (14%) started regular hemodialysis.
  
  
  CONCLUSIONS
  IFI still have a high mortality and morbidity in kidney transplant recipients, as verified in this report. We reinforce the need for a high index of suspicion and prompt treatment.
authors.affiliation: Kidney Transplant Unit, Urology and Kidney Transplant Department, Coimbra University Hospital, Coimbra, Portugal. Electronic address: telmamorimsantos@gmail.com.
authors.forename: T
authors.initials: T
authors.lastname: Santos
authors.affiliation: Kidney Transplant Unit, Urology and Kidney Transplant Department, Coimbra University Hospital, Coimbra, Portugal.
authors.forename: B
authors.initials: B
authors.lastname: Aguiar
authors.affiliation: Kidney Transplant Unit, Urology and Kidney Transplant Department, Coimbra University Hospital, Coimbra, Portugal.
authors.forename: L
authors.initials: L
authors.lastname: Santos
authors.affiliation: Kidney Transplant Unit, Urology and Kidney Transplant Department, Coimbra University Hospital, Coimbra, Portugal.
authors.forename: C
authors.initials: C
authors.lastname: Romaozinho
authors.affiliation: Clinical Pathology Department, Coimbra University Hospital, Coimbra, Portugal.
authors.forename: R
authors.initials: R
authors.lastname: Tome
authors.affiliation: Kidney Transplant Unit, Urology and Kidney Transplant Department, Coimbra University Hospital, Coimbra, Portugal.
authors.forename: F
authors.initials: F
authors.lastname: Macario
authors.affiliation: Kidney Transplant Unit, Urology and Kidney Transplant Department, Coimbra University Hospital, Coimbra, Portugal.
authors.forename: R
authors.initials: R
authors.lastname: Alves
authors.affiliation: Nephrology Department, Coimbra University Hospital, Coimbra, Portugal.
authors.forename: M
authors.initials: M
authors.lastname: Campos
authors.affiliation: Kidney Transplant Unit, Urology and Kidney Transplant Department, Coimbra University Hospital, Coimbra, Portugal.
authors.forename: A
authors.initials: A
authors.lastname: Mota
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D011183:Postoperative Complications; D012189:Retrospective Studies; D014019:Tissue Donors; D055815:Young Adult
chemical_list: D000935:Antifungal Agents