Veroux M, Macarone M, Fiamingo P, Cappello D, Gagliano M, Di Mare M, Vizcarra D, Spataro M, Giuffrida G, Sorbello M, Severino V, Veroux P
Department of Surgery, Transplantation and Advanced Technologies, Organ Transplant Unit, University Hospital of Catania, Italy.
Transplant Proc. 2006 May;38(4):1037-9. doi: 10.1016/j.transproceed.2006.03.050.
Infection is a common cause of morbidity and mortality in kidney transplant recipients. The incidence of esophageal and urogenital candidiasis in kidney and kidney-pancreas transplant recipients has not been well documented. Azoles are safe, effective agents to treat esophageal candidiasis. However, resistance to azoles is now becoming common. This study reports the use of caspofungin for the treatment of azole-resistant esophageal and urogenital candidiasis in kidney transplant recipients.
The incidence of esophageal and urogenital candidiasis was evaluated among 140 kidney transplantations and four combined kidney-pancreas transplants performed over a 2-year period.
Twenty-two patients (15.7%) presented with esophageal candidiasis, while seven patients (5%) showed urogenital candidiasis. Thirteen patients with esophageal candidiasis (59%) and four patients (57%) with urogenital candidiasis did not improve after a week of azole treatment. A regimen of caspofungin was started in these patients, who tolerated the treatment. Urogenital candidiasis recurred in two patients 2 and 3 months after the treatment. One patient with esophageal candidiasis did not improve with caspofungin and was switched to amphotericin B therapy. There were no other recurrences of candidiasis among patients treated with caspofungin for a median follow-up of 8 months.
Renal transplant patients remain at high risk for fungal infections. Although the number of patients was limited, the results of this study indicated that caspofungin is an effective, well-tolerated alternative for difficult-to-treat, azole-resistant candida infections in kidney and pancreas transplant recipients. The high costs of the drug limit the use of caspofungin as first-line antifungal therapy, reserving its use to recipients who had undergone unsuccessful azole therapy.
感染是肾移植受者发病和死亡的常见原因。肾移植和肾胰联合移植受者中食管和泌尿生殖道念珠菌病的发病率尚未得到充分记录。唑类药物是治疗食管念珠菌病的安全有效药物。然而，目前对唑类药物的耐药性正变得普遍。本研究报告了卡泊芬净在治疗肾移植受者对唑类耐药的食管和泌尿生殖道念珠菌病中的应用。
在2年期间进行的140例肾移植和4例肾胰联合移植中评估食管和泌尿生殖道念珠菌病的发病率。
22例患者（15.7%）出现食管念珠菌病，7例患者（5%）出现泌尿生殖道念珠菌病。13例食管念珠菌病患者（59%）和4例泌尿生殖道念珠菌病患者（57%）在接受唑类治疗1周后病情未改善。这些患者开始使用卡泊芬净治疗方案，他们对该治疗耐受。2例患者在治疗后2个月和3个月泌尿生殖道念珠菌病复发。1例食管念珠菌病患者使用卡泊芬净治疗效果不佳，改用两性霉素B治疗。接受卡泊芬净治疗的患者中，中位随访8个月，念珠菌病无其他复发情况。
肾移植患者仍有较高的真菌感染风险。尽管患者数量有限，但本研究结果表明，卡泊芬净是治疗肾和胰腺移植受者难以治疗的、对唑类耐药的念珠菌感染的有效且耐受性良好的替代药物。该药物的高成本限制了其作为一线抗真菌治疗的应用，仅用于唑类治疗失败的受者。
