Shekar Manikantan, Elumalai Ramprasad, Elayaperumal Indhumathi, Yelahanka Renuka Prasad, Anandkumar Deepashree G, Bandi Varun Kumar, Matcha Jayakumar
Department of Nephrology, Sri Ramachandra Medical College, Bengaluru, Karnataka, India.
Department of Nephrology, Fortis Hospitals, Bengaluru, Karnataka, India.
Saudi J Kidney Dis Transpl. 2019 Sep-Oct;30(5):1137-1143. doi: 10.4103/1319-2442.270270.
Fungal infections are an important cause of morbidity and mortality in renal transplant recipients. These infections account for 5% of all infections in renal transplant recipients. The symptoms of systemic fungal infections are nonspecific, particularly in their early stages, and this can lead to delay in diagnosis. Retrospective analysis was conducted on all renal transplants that were performed at our center over a 20-year period from 1996-2016. Cases of invasive fungal infections (IFIs) that occurred among renal transplant recipients were identified to describe the epidmeiology of these infections. A total of 67 (9.2%) IFI cases were identified among 725 renal transplant recipients. Of the 67 patients (9.24%) with IFI, 31 (46.2%) cases were seen in deceased donor transplant recipients. Of 67 cases with IFI, 42 (62.7%) had received induction therapy. The incidence of fungal infections according to the induction agent used was, 14.3% with basiliximab, 12.3% each with daclizumab and rabbit antithymocyte globulin, and 6.3% among patients not given any induction. Invasive candidiasis was the most common IFI overall, followed by mucormycosis, invasive aspergillosis, and cryptococcosis. Median time to onset of IFI was 117.9 days. Majority of infections occurred within 180 days after transplantation. Late posttransplant (>180 days after transplantation) IFI's were predominantly caused by Candida, followed by Cryptococcus. The longest time to infection was a case of histoplasma, occurring seven years posttransplant. The overall 12-month cumulative incidence (CI) for any IFI was 9.1%. The 12-month CI of the first IFI increased from 7.3% between 1996 and 2001 to 10.5% between 2010 and 2016. The overall mortality rate was 38.8%. The use of newer and more-effective immunosuppressive agents in recent years are associated with increased rates of fungal infections in renal transplant recipients. Therefore, early detection of fungal infections and proper therapy are important in improving survival and reducing mortality.
真菌感染是肾移植受者发病和死亡的重要原因。这些感染占肾移植受者所有感染的5%。系统性真菌感染的症状不具有特异性，尤其是在早期阶段，这可能导致诊断延迟。对1996年至2016年期间在本中心进行的所有肾移植手术进行了回顾性分析。确定肾移植受者中发生的侵袭性真菌感染（IFI）病例，以描述这些感染的流行病学情况。在725名肾移植受者中，共确定了67例（9.2%）IFI病例。在67例（9.24%）患有IFI的患者中，31例（46.2%）出现在已故供体移植受者中。在67例IFI病例中，42例（62.7%）接受了诱导治疗。根据所使用的诱导剂，真菌感染的发生率分别为：巴利昔单抗为14.3%，达利珠单抗和兔抗胸腺细胞球蛋白均为12.3%，未接受任何诱导治疗的患者为6.3%。侵袭性念珠菌病是总体上最常见的IFI，其次是毛霉病、侵袭性曲霉病和隐球菌病。IFI发病的中位时间为117.9天。大多数感染发生在移植后180天内。移植后期（移植后>180天）的IFI主要由念珠菌引起，其次是隐球菌。感染时间最长的是1例组织胞浆菌病，发生在移植后7年。任何IFI的总体12个月累积发病率（CI）为9.1%。首次IFI的12个月CI从1996年至2001年期间的7.3%上升至2010年至2016年期间的10.5%。总体死亡率为38.8%。近年来使用更新、更有效的免疫抑制剂与肾移植受者真菌感染率增加有关。因此，早期发现真菌感染并进行适当治疗对于提高生存率和降低死亡率很重要。
