INVASIVE FUNGAL INFECTIONS IN RENAL TRANSPLANT RECIPIENTS: A SINGLE CENTRE STUDY

8 Feb 2025 12 a.m. 12 a.m.

WCN25-AB-3837, Poster Board= SAT-393

Introduction:

Fungi constitute around 5% of all infections in renal transplant (RT) recipients. Though the incidence of invasive fungal infections (IFI) in RT recipients is lower than other solid organ transplant (SOT), their burden in RT recipients is higher because of greater numbers of RT than other SOTs. In this study we aim to evaluate the epidemiology, risk factors and outcome of IFI in RT recipients.

Methods:

This was a single-centre, retrospective observational study of 1051 patients who underwent transplant between January 2014 and January 2024. Proven IFI was defined as presence of fungal elements in tissue samples by histology and/or culture. Demographic profile included age, gender, date of transplant, type of donor (living or deceased), HLA-matching, immunosuppressive therapy, time to onset and site of infection. Specimens tested were sputum, bronchoalveolar lavage, cerebrospinal fluid, abscess, tissue, and blood. Mucocutaneous infections was excluded due to non-invasive nature and most of these patients were treated on outpatient basis.

Results:

Figure 1. Kaplan Meir curves for incidence of invasive fungal infections in patients receiving antithymocyte globulin, Basiliximab or no drug for induction Figure 2. Sites of fungal infections (n=49). *Others – Rhinosinusitis, Liver and Graft kidney Figure 3. Fungal isolates (n=53) *Others – Histoplasmosis and candidiasis

Among 1051 RT recipients, IFI was diagnosed in 46 (4.5%) patients representing 49 instances of fungal infections and 53 fungal isolates. Three patients developed recurrent infection. Thirty-eight (82.6%) patients were males, largely because more males underwent RT. The median age was 40 (31-48) years. Majority (n = 41) were live related RT, while 5 were deceased donor RT. Median HLA-mismatch was 3 (3-4) and 3 patients were ABO incompatible. Basiliximab was the most common induction agent in 19 (41.3%) patients whereas antithymocyte globulin (ATG) was given in 10 (21.7%) patients. Seventeen (37.0%) patients were transplanted without any induction therapy. All patients were on triple immunosuppression therapy with tacrolimus, mycophenolate mofetil (MMF), and prednisolone at time of infection. Risk factors for IFI were diabetes mellitus (DM) in 20 (43.5%) patients (7 having type 2 DM whereas 13 patients had new onset DM after transplant), prior cytomegalovirus infection in 8 (17.4%) patients, and anti-rejection therapy in 5 (10.9%) patients. Median time from transplant to IFI was 9.5 (4-18) months and median duration for recovery or death was 46 (33-72) days. There was no significant difference in incidence of IFI among patients receiving basiliximab or ATG as compared to patients receiving no induction therapy (Figure 1). Lungs was most common site in 37 (75.5%) instances followed by CNS and skeletal in 8 (16.3%) and 4 (8.2%) instances respectively (Figure 2). Among 53 fungal isolates, aspergillosis and mucormycosis was seen in 16 (30.2%) and 15 (28.3%) times respectively. Pneumocystis carnii pneumonia (PCP) and cryptococcosis were each seen on 9 (17.0%) occasions (Figure 3). Eight patients (16.3%) expired of which aspergillosis was present in 4 patients, mucormycosis and histoplasmosis each in 2 patients and 1 patient each having PCP and invasive candidal infection. Post IFI, MMF was stopped in 30 (78.9%) patients of which 7 (18.4%) developed graft rejection whereas none of the 8 patients where MMF was continued had graft rejection.

Conclusions:

Aspergillosis and mucormycosis were most common IFI in RT recipients with lungs being the most common site. The induction agent did not influence the occurrence of IFI. Management of IFI required discontinuation of MMF leading to graft rejection in 18.4% patients.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.