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Fungal Infections in Renal Transplant Patients

Organ transplantation has always been considered to be the standard therapeutic interventions in patients with end-stage organ failure. In 2008, more than 29,000 organ transplants were performed in US. Survival rates among transplant recipients have greatly improved due to better understanding of tr...

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Autores principales: Khan, Asif, El-Charabaty, Elie, El-Sayegh, Suzanne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elmer Press 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4394908/
https://www.ncbi.nlm.nih.gov/pubmed/25883698
http://dx.doi.org/10.14740/jocmr2104w
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author Khan, Asif
El-Charabaty, Elie
El-Sayegh, Suzanne
author_facet Khan, Asif
El-Charabaty, Elie
El-Sayegh, Suzanne
author_sort Khan, Asif
collection PubMed
description Organ transplantation has always been considered to be the standard therapeutic interventions in patients with end-stage organ failure. In 2008, more than 29,000 organ transplants were performed in US. Survival rates among transplant recipients have greatly improved due to better understanding of transplant biology and more effective immunosuppressive agents. After transplant, the extent of the immune response is influenced by the amount of interleukin 2 (IL-2) being produced by the T-helper cells. Transplant immunosuppressive therapy primarily targets T cell-mediated graft rejection. Calcineurin inhibitor, which includes cyclosporine, pimecrolimus and tacrolimus, impairs calcineurin-induced up-regulation of IL-2 expression, resulting in increased susceptibility to invasive fungal diseases. This immunosuppressive state allows infectious complication, leading to a high mortality rate. Currently, overall mortality due to invasive fungal infections (IFIs) in solid organ transplant recipients ranges between 25% and 80%. The risk of IFI following renal transplant is associated with the dosage of immunosuppressive agents given, environmental factors and post-transplant duration. Most fungal infections occur in the first 6 months after transplant because of the use of numerous immunosuppressors. Candida spp. and Cryptococcus spp. are the yeasts most frequently isolated, while most frequent filamentous fungi (molds) isolated are Aspergillus spp. The symptoms of systemic fungal infections are non-specific and early detection of fungal infections and proper therapy are important in improving survival and reducing mortality. This article will provide an insight on the risk factors and clinical presentation, compare variation in treatment of IFIs in renal transplant patients, and evaluate the role of prophylactic therapy in this group of patients. We also report the course and management of two renal transplant recipients admitted to Staten Island University Hospital, both of whom developed pulmonary complications secondary to Aspergillus infection.
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spelling pubmed-43949082015-04-16 Fungal Infections in Renal Transplant Patients Khan, Asif El-Charabaty, Elie El-Sayegh, Suzanne J Clin Med Res Review Organ transplantation has always been considered to be the standard therapeutic interventions in patients with end-stage organ failure. In 2008, more than 29,000 organ transplants were performed in US. Survival rates among transplant recipients have greatly improved due to better understanding of transplant biology and more effective immunosuppressive agents. After transplant, the extent of the immune response is influenced by the amount of interleukin 2 (IL-2) being produced by the T-helper cells. Transplant immunosuppressive therapy primarily targets T cell-mediated graft rejection. Calcineurin inhibitor, which includes cyclosporine, pimecrolimus and tacrolimus, impairs calcineurin-induced up-regulation of IL-2 expression, resulting in increased susceptibility to invasive fungal diseases. This immunosuppressive state allows infectious complication, leading to a high mortality rate. Currently, overall mortality due to invasive fungal infections (IFIs) in solid organ transplant recipients ranges between 25% and 80%. The risk of IFI following renal transplant is associated with the dosage of immunosuppressive agents given, environmental factors and post-transplant duration. Most fungal infections occur in the first 6 months after transplant because of the use of numerous immunosuppressors. Candida spp. and Cryptococcus spp. are the yeasts most frequently isolated, while most frequent filamentous fungi (molds) isolated are Aspergillus spp. The symptoms of systemic fungal infections are non-specific and early detection of fungal infections and proper therapy are important in improving survival and reducing mortality. This article will provide an insight on the risk factors and clinical presentation, compare variation in treatment of IFIs in renal transplant patients, and evaluate the role of prophylactic therapy in this group of patients. We also report the course and management of two renal transplant recipients admitted to Staten Island University Hospital, both of whom developed pulmonary complications secondary to Aspergillus infection. Elmer Press 2015-06 2015-04-08 /pmc/articles/PMC4394908/ /pubmed/25883698 http://dx.doi.org/10.14740/jocmr2104w Text en Copyright 2015, Khan et al. http://creativecommons.org/licenses/by/2.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review
Khan, Asif
El-Charabaty, Elie
El-Sayegh, Suzanne
Fungal Infections in Renal Transplant Patients
title Fungal Infections in Renal Transplant Patients
title_full Fungal Infections in Renal Transplant Patients
title_fullStr Fungal Infections in Renal Transplant Patients
title_full_unstemmed Fungal Infections in Renal Transplant Patients
title_short Fungal Infections in Renal Transplant Patients
title_sort fungal infections in renal transplant patients
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4394908/
https://www.ncbi.nlm.nih.gov/pubmed/25883698
http://dx.doi.org/10.14740/jocmr2104w
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