Korean J Transplant.  2022 Nov;36(Supple 1):S296. 10.4285/ATW2022.F-4363.

Epidemiology and outcomes of extrapulmonary fungal infections among kidney transplant recipients: a tertiary care experience

• Ansari A
• Kaul A
• Prasad N
• Bhadauria D
• Behera MR

• KMID: 2535523
• DOI: http://doi.org/10.4285/ATW2022.F-4363

Abstract

Background
With the advances in post-transplant care leading to improved kidney graft and patient survival, the incidence of fungal infections has also increased. The published data regarding extrapulmonary fungal infection is few and lacking. The aim is to study the clinical profile, etiology, risk factors, treatment, and outcome of extrapulmonary fungal infections in kidney transplant recipients.
Methods
This is a 15-year retrospective observational study from January 2007 to December 2021 conducted at Sanjay Gandhi Postgraduate Institute of Medical Sciences, wherein kidney transplant recipients with extrapulmonary fungal infection were in-cluded and followed.
Results
Extrapulmonary fungal infections were diagnosed in 103 of 1,649 recipients (6.3%) with mean age of 44.56 years. Mean duration of acquiring infection posttransplant was 35.68 months, and mean serum creatinine at presentation was 2.00 mg/ dL. Majority of donors were living related (n=100). Ninety-seven transplants were ABO-compatible, whereas six were ABO-in-compatible. Forty-six patients received basiliximab induction, 18 received antithymocyte globulin, one received daclizumab, whereas 35 did not receive any induction. Most common extrapulmonary fungal infection was phaeohyphomycosis (37.9%; 37 subcutaneous, one nasal, one central nervous system [CNS]), followed by candidiasis (27.2%; 23 GI, one subcutaneous, one graft, three others) and cryptococcosis (18.5%; 18 CNS, one disseminated). Five patients (4.9%) had evidence of dual fungal infections. Diabetes mellitus (53.9%), cytomegalovirus infection (9.7%), antirejection therapy (43.7%), hepatitis C (6.8%), and hepatitis B (7.8%) were risk factors identified. The immediate patient outcomes were nine death (8.7%), three discharge against medical advice (2.9%), and 78 normal discharge (75.7%). Thirty-nine patients (37.9%) had evidence of graft dysfunction, but only four (3.9%) had graft loss. During long-term follow-up, 12 patients (11.7%) had graft loss and 29 patients (28.2%) died. Further, 23 patients (22.3%) were lost to follow-up.
Conclusions
Extrapulmonary fungal infection may range from benign lesions like phaeohyphomycosis to fatal cryptococcal meningitis. Prevention, early diagnosis, and appropriate management are necessary to improve their prognosis and quality of life.