Seok Hyeri, Huh Kyungmin, Cho Sun Young, Kang Cheol-In, Chung Doo Ryeon, Huh Woo Seong, Park Jae Berm, Peck Kyong Ran
Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
Division of Infectious Diseases, Department of Medicine, Korea University Ansan Hospital, Ansan 15355, Korea.
J Clin Med. 2020 Jun 11;9(6):1824. doi: 10.3390/jcm9061824.
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.
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.
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, = 0.011) and acute rejection (OR 3.41, 95% CI 1.41-8.21, = 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, = 0.001), and delayed graft function was associated with IA occurrence (OR 10.60, 95% CI 1.05-106.84, = 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, = 0.004), or those with DM (aHR 2.61, 95% CI 1.02-6.68, = 0.044), deceased donor transplantation (aHR 2.68, 95% CI 1.03-6.95, = 0.043), lymphocyte-depleting antibody usage (aHR 0.26, 95% CI 0.08-0.80, = 0.019), acute rejection (aHR 0.38, 95% CI 0.15-0.97, = 0.044), and concomitant bacterial infection (aHR 8.76, 95% CI 1.62-47.51, = 0.012).
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.
侵袭性真菌病（IFD）在实体器官移植（SOT）受者中很常见，会导致高发病率和高死亡率。尽管肾移植（KT）是一种常见的实体器官移植手术，但关于IFD相关死亡率的危险因素的数据有限。
在韩国一家经验丰富的单中心进行了一项1:2回顾性病例对照研究。我们回顾了1995年2月至2015年3月期间肾移植后发生IFD患者的电子病历。
在1963例肾移植受者中，48例（2.5%）被诊断为IFD。从肾移植到IFD诊断的中位间隔时间为172天。侵袭性曲霉病（IA）最为常见，其次是侵袭性念珠菌病（IC）。糖尿病（DM）（比值比（OR）3.72，95%置信区间（CI）1.34 - 10.31，P = 0.011）和急性排斥反应（OR 3.41，95% CI 1.41 - 8.21，P = 0.006）与IFD的发生相关。在亚组分析中，合并细菌感染与IC的发生相关（OR 20.10，95% CI 3.60 - 112.08，P = 0.001），移植肾功能延迟与IA的发生相关（OR 10.60，95% CI 1.05 - 106.84，P = 0.045）。所有患者的12周死亡率为50.0%。老年患者（校正风险比（aHR）1.06，95% CI 1.02 - 1.11，P = 0.004）、患有DM的患者（aHR 2.61，95% CI 1.02 - 6.68，P = 0.044）、死亡供体移植患者（aHR 2.68，95% CI 1.03 - 6.95，P = 用淋巴细胞清除抗体的患者（aHR 0.26，95% CI 0.08 - 0.80，P = 0.019）、发生急性排斥反应的患者（aHR 0.38，95% CI 0.15 - 0.97，P = 0.044）以及合并细菌感染的患者（aHR 8.76，95% CI 1.62 - 47.51，P = 0.012）的死亡率显著更高。
总共50%的IFD病例发生在移植后6个月或更晚。尽管发病率较低，但肾移植受者中IFD相关死亡率较高。DM和急性排斥反应与高死亡率以及IFD的发生相关。由于老年、死亡供体移植、淋巴细胞清除抗体的使用以及合并细菌感染是IFD相关死亡率的危险因素，因此需要努力进行早期诊断和适当治疗。 0.043）、
