Cargando…

Invasive Fungal Diseases in Kidney Transplant Recipients: Risk Factors for Mortality

Background: Invasive fungal disease (IFD) is common in solid organ transplant (SOT) recipients and contributes to high morbidity and mortality. Although kidney transplantation (KT) is a commonly performed SOT, data on the risk factors for IFD-related mortality are limited. Methods: A 1:2 retrospecti...

Descripción completa

Detalles Bibliográficos
Autores principales: Seok, Hyeri, Huh, Kyungmin, Cho, Sun Young, Kang, Cheol-In, Chung, Doo Ryeon, Huh, Woo Seong, Park, Jae Berm, Peck, Kyong Ran
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7357124/
https://www.ncbi.nlm.nih.gov/pubmed/32545280
http://dx.doi.org/10.3390/jcm9061824
_version_ 1783558641211670528
author Seok, Hyeri
Huh, Kyungmin
Cho, Sun Young
Kang, Cheol-In
Chung, Doo Ryeon
Huh, Woo Seong
Park, Jae Berm
Peck, Kyong Ran
author_facet Seok, Hyeri
Huh, Kyungmin
Cho, Sun Young
Kang, Cheol-In
Chung, Doo Ryeon
Huh, Woo Seong
Park, Jae Berm
Peck, Kyong Ran
author_sort Seok, Hyeri
collection PubMed
description Background: Invasive fungal disease (IFD) is common in solid organ transplant (SOT) recipients and contributes to high morbidity and mortality. Although kidney transplantation (KT) is a commonly performed SOT, data on the risk factors for IFD-related mortality are limited. Methods: A 1:2 retrospective case-control study was performed in an experienced single center in the Republic of Korea. We reviewed the electronic medical records of patients with IFD after KT between February 1995 and March 2015. Results: Of 1963 kidney transplant recipients, 48 (2.5%) were diagnosed with IFD. The median interval from KT to IFD diagnosis was 172 days. Invasive aspergillosis (IA) was the most common, followed by invasive candidiasis (IC). Diabetes mellitus (DM) (odds ratio (OR) 3.72, 95% confidence interval (CI) 1.34–10.31, p = 0.011) and acute rejection (OR 3.41, 95% CI 1.41–8.21, p = 0.006) were associated with IFD development. In the subgroup analyses, concomitant bacterial infection was associated with IC development (OR 20.10, 95% CI 3.60–112.08, p = 0.001), and delayed graft function was associated with IA occurrence (OR 10.60, 95% CI 1.05–106.84, p = 0.045). The 12-week mortality rate in all patients was 50.0%. Mortality rates were significantly higher in older patients (adjusted hazard ratio (aHR) 1.06, 95% CI 1.02–1.11, p = 0.004), or those with DM (aHR 2.61, 95% CI 1.02–6.68, p = 0.044), deceased donor transplantation (aHR 2.68, 95% CI 1.03–6.95, p = 0.043), lymphocyte-depleting antibody usage (aHR 0.26, 95% CI 0.08–0.80, p = 0.019), acute rejection (aHR 0.38, 95% CI 0.15–0.97, p = 0.044), and concomitant bacterial infection (aHR 8.76, 95% CI 1.62–47.51, p = 0.012). Conclusions: A total of 50% of IFD cases occurred six months or later after transplantation. The IFD-related mortality rate was high in kidney transplant recipients despite the low incidence. DM and acute rejection were associated with high mortality, as well as IFD development. As old age, deceased donor transplantation, lymphocyte-depleting antibody usage, and concomitant bacterial infection are risk factors for IFD-related mortality, efforts for its early diagnosis and appropriate treatment are required.
format Online
Article
Text
id pubmed-7357124
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-73571242020-07-23 Invasive Fungal Diseases in Kidney Transplant Recipients: Risk Factors for Mortality Seok, Hyeri Huh, Kyungmin Cho, Sun Young Kang, Cheol-In Chung, Doo Ryeon Huh, Woo Seong Park, Jae Berm Peck, Kyong Ran J Clin Med Article Background: Invasive fungal disease (IFD) is common in solid organ transplant (SOT) recipients and contributes to high morbidity and mortality. Although kidney transplantation (KT) is a commonly performed SOT, data on the risk factors for IFD-related mortality are limited. Methods: A 1:2 retrospective case-control study was performed in an experienced single center in the Republic of Korea. We reviewed the electronic medical records of patients with IFD after KT between February 1995 and March 2015. Results: Of 1963 kidney transplant recipients, 48 (2.5%) were diagnosed with IFD. The median interval from KT to IFD diagnosis was 172 days. Invasive aspergillosis (IA) was the most common, followed by invasive candidiasis (IC). Diabetes mellitus (DM) (odds ratio (OR) 3.72, 95% confidence interval (CI) 1.34–10.31, p = 0.011) and acute rejection (OR 3.41, 95% CI 1.41–8.21, p = 0.006) were associated with IFD development. In the subgroup analyses, concomitant bacterial infection was associated with IC development (OR 20.10, 95% CI 3.60–112.08, p = 0.001), and delayed graft function was associated with IA occurrence (OR 10.60, 95% CI 1.05–106.84, p = 0.045). The 12-week mortality rate in all patients was 50.0%. Mortality rates were significantly higher in older patients (adjusted hazard ratio (aHR) 1.06, 95% CI 1.02–1.11, p = 0.004), or those with DM (aHR 2.61, 95% CI 1.02–6.68, p = 0.044), deceased donor transplantation (aHR 2.68, 95% CI 1.03–6.95, p = 0.043), lymphocyte-depleting antibody usage (aHR 0.26, 95% CI 0.08–0.80, p = 0.019), acute rejection (aHR 0.38, 95% CI 0.15–0.97, p = 0.044), and concomitant bacterial infection (aHR 8.76, 95% CI 1.62–47.51, p = 0.012). Conclusions: A total of 50% of IFD cases occurred six months or later after transplantation. The IFD-related mortality rate was high in kidney transplant recipients despite the low incidence. DM and acute rejection were associated with high mortality, as well as IFD development. As old age, deceased donor transplantation, lymphocyte-depleting antibody usage, and concomitant bacterial infection are risk factors for IFD-related mortality, efforts for its early diagnosis and appropriate treatment are required. MDPI 2020-06-11 /pmc/articles/PMC7357124/ /pubmed/32545280 http://dx.doi.org/10.3390/jcm9061824 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Seok, Hyeri
Huh, Kyungmin
Cho, Sun Young
Kang, Cheol-In
Chung, Doo Ryeon
Huh, Woo Seong
Park, Jae Berm
Peck, Kyong Ran
Invasive Fungal Diseases in Kidney Transplant Recipients: Risk Factors for Mortality
title Invasive Fungal Diseases in Kidney Transplant Recipients: Risk Factors for Mortality
title_full Invasive Fungal Diseases in Kidney Transplant Recipients: Risk Factors for Mortality
title_fullStr Invasive Fungal Diseases in Kidney Transplant Recipients: Risk Factors for Mortality
title_full_unstemmed Invasive Fungal Diseases in Kidney Transplant Recipients: Risk Factors for Mortality
title_short Invasive Fungal Diseases in Kidney Transplant Recipients: Risk Factors for Mortality
title_sort invasive fungal diseases in kidney transplant recipients: risk factors for mortality
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7357124/
https://www.ncbi.nlm.nih.gov/pubmed/32545280
http://dx.doi.org/10.3390/jcm9061824
work_keys_str_mv AT seokhyeri invasivefungaldiseasesinkidneytransplantrecipientsriskfactorsformortality
AT huhkyungmin invasivefungaldiseasesinkidneytransplantrecipientsriskfactorsformortality
AT chosunyoung invasivefungaldiseasesinkidneytransplantrecipientsriskfactorsformortality
AT kangcheolin invasivefungaldiseasesinkidneytransplantrecipientsriskfactorsformortality
AT chungdooryeon invasivefungaldiseasesinkidneytransplantrecipientsriskfactorsformortality
AT huhwooseong invasivefungaldiseasesinkidneytransplantrecipientsriskfactorsformortality
AT parkjaeberm invasivefungaldiseasesinkidneytransplantrecipientsriskfactorsformortality
AT peckkyongran invasivefungaldiseasesinkidneytransplantrecipientsriskfactorsformortality