title: Invasive fungal infections in renal transplant patients: a single center study.
abstract: BACKGROUND
  Timely diagnosis of invasive fungal infections (IFI) in renal transplant (RT) patients on immunosuppression is often difficult, jeopardizing their life and graft. We reported IFI and their causative fungal agents in post-RT patients.
  
  
  METHODS
  This was a retrospective 6-year clinical study carried out from 2010 to 2015 on 1900 RT patients. Clinical data included patient-donor demographics, time to onset of infection, risk factors and graft function in terms of serum creatinine (SCr). To identify IFI, we examined bronchoalveolar lavage (BAL), blood, tissue, and wound swab samples by conventional mycological methods.
  
  
  RESULTS
  IFI were diagnosed in 30 (1.56%) patients on triple immunosuppression, mainly males (n = 25) with mean age of 36.57 ± 11.9 years at 13.12 ± 18.35 months post-RT. Aspergillus species was identified in 11 BAL, one tissue, and one wound specimen each, 30.76% of these were fatal and 15.38% caused graft loss; Candida albicans was in nine BAL, four blood, two wound swab, and one tissue specimens, 25% of these were fatal and 25% had graft loss and one mucor in BAL which was fatal. Seven patients were diabetic, 10 had superadded cytomegalovirus infection, and 15 were anti-rejected.
  
  
  CONCLUSIONS
  IFI are associated with increased morbidity and mortality in RT patients. Triple immunosuppression, broad spectrum antibiotics for ≥ two weeks, diabetes and superadded infection are added risks for these patients. Prevention, early diagnosis, and appropriate management are necessary to improve their prognosis.
authors.affiliation: a Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology , IKDRC-ITS , Ahmedabad , India.
authors.forename: Minaxi H
authors.initials: MH
authors.lastname: Patel
authors.affiliation: a Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology , IKDRC-ITS , Ahmedabad , India.
authors.forename: Rashmi D
authors.initials: RD
authors.lastname: Patel
authors.affiliation: a Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology , IKDRC-ITS , Ahmedabad , India.
authors.forename: Aruna V
authors.initials: AV
authors.lastname: Vanikar
authors.affiliation: a Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology , IKDRC-ITS , Ahmedabad , India.
authors.forename: Kamal V
authors.initials: KV
authors.lastname: Kanodia
authors.affiliation: a Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology , IKDRC-ITS , Ahmedabad , India.
authors.forename: Kamlesh S
authors.initials: KS
authors.lastname: Suthar
authors.affiliation: a Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology , IKDRC-ITS , Ahmedabad , India.
authors.forename: Lovelesh K
authors.initials: LK
authors.lastname: Nigam
authors.affiliation: b Department of Nephrology and Clinical Transplantation , Institute of Kidney Diseases and Research Center, Dr H.L. Trivedi Institute of Transplantation Sciences (IKDRC-ITS) , Ahmedabad , India.
authors.forename: Himanshu V
authors.initials: HV
authors.lastname: Patel
authors.affiliation: b Department of Nephrology and Clinical Transplantation , Institute of Kidney Diseases and Research Center, Dr H.L. Trivedi Institute of Transplantation Sciences (IKDRC-ITS) , Ahmedabad , India.
authors.forename: Ansy H
authors.initials: AH
authors.lastname: Patel
authors.affiliation: b Department of Nephrology and Clinical Transplantation , Institute of Kidney Diseases and Research Center, Dr H.L. Trivedi Institute of Transplantation Sciences (IKDRC-ITS) , Ahmedabad , India.
authors.forename: Vivek B
authors.initials: VB
authors.lastname: Kute
authors.affiliation: b Department of Nephrology and Clinical Transplantation , Institute of Kidney Diseases and Research Center, Dr H.L. Trivedi Institute of Transplantation Sciences (IKDRC-ITS) , Ahmedabad , India.
authors.forename: Hargovind L
authors.initials: HL
authors.lastname: Trivedi
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage*; D000935:Antifungal Agents / Q000008:administration & dosage; D001230:Aspergillus / Q000302:isolation & purification; D002176:Candida albicans / Q000302:isolation & purification; D005260:Female; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects / Q000379:methods; D007194:India / Q000453:epidemiology; D000072742:Invasive Fungal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D012189:Retrospective Studies; D019737:Transplants / Q000382:microbiology*
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B
keywords: Aspergillus; Candida albicans; Invasive fungal infection; Mucor; Renal transplant