Invasive Fungal Disease in Renal Transplant Recipients at a Brazilian Center: Local Epidemiology Matters

Abstract Introduction Invasive fungal disease (IFD) is an important complication after solid organ transplantation (SOT). A marked geographic variation in the epidemiology of IFD after kidney transplantation (KT) has been suggested by the results of previous studies. Nevertheless, data from Latin Am...

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Published in:Transplantation proceedings 2016-09, Vol.48 (7), p.2306-2309
Main Authors: Guimarães, L.F.A, Halpern, M, de Lemos, A.S, de Gouvêa, E.F, Gonçalves, R.T, da Rosa Santos, M.A.A, Nucci, M, Santoro-Lopes, G
Format: Article
Language:English
Subjects:
Adult
Antilymphocyte Serum - therapeutic use
Brazil - epidemiology
Candidiasis, Invasive - epidemiology
Cryptococcosis - epidemiology
Female
Graft Rejection - prevention & control
Histoplasmosis - epidemiology
Humans
Immunosuppressive Agents - therapeutic use
Invasive Pulmonary Aspergillosis - epidemiology
Kidney Transplantation
Male
Middle Aged
Mucormycosis - epidemiology
Mycoses - epidemiology
Postoperative Complications - epidemiology
Retrospective Studies
Risk Factors
Surgery
Transplant Recipients
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Summary:Abstract Introduction Invasive fungal disease (IFD) is an important complication after solid organ transplantation (SOT). A marked geographic variation in the epidemiology of IFD after kidney transplantation (KT) has been suggested by the results of previous studies. Nevertheless, data from Latin American centers are scarce. Objective This study sought to describe the epidemiology of IFD at a Brazilian KT center. Methods This study was a retrospective single-center cohort study that included patients who underwent KT between 1998 and 2009 and were followed up until July 2015. Cases of simultaneous kidney-pancreas transplantation were excluded. The primary study outcome was the occurrence of proven or probable IFD. Results Among 908 KT recipients, 44 cases of IFD occurred in 42 patients (4.6%). Cryptococcus spp. infection, diagnosed in 16 cases (36.3%), was the leading cause of IFD, followed by histoplasmosis in 10 cases (22.7%) and invasive candidiasis in 10 (22.7%). Sporotrichosis, mucormycosis, invasive aspergillosis, pulmonary Cladophialophora sp. infection, trichosporonosis and Saccharomyces cerevisiae fungemia occurred in 1 recipient each (2.3%). Two additional (4.5%) cases of unspecified mold infections were identified by histopathological analysis. Most cases of IFD (67%) occurred later than 6 months after transplantation. Previous use of antilymphocyte antibodies ( P  = .008) and corticosteroid pulse therapy ( P  < .001) were more frequent among cases of IFD occurring within the first 6 months after transplantation. Conclusions The epidemiology of IFD in this Brazilian cohort was characterized by a large predominance of late infections and a high proportion of cases of cryptococcosis and histoplasmosis. These results highlight the considerable geographic variability of IFD epidemiology after KT.
ISSN:0041-1345
1873-2623
DOI:10.1016/j.transproceed.2016.06.019