| Kidney transplantation by D.W Denning |
|---|
| Historically, kidney transplant recipients have been thought to be at a lower risk for invasive aspergillosis (IA) than other solid organ transplant recipients. In a large retrospective review of 296 kidney graft recipients from 1986-1999, the overall incidence of invasive fungal infection (IFI) was 4% (Altiparmak et al, 2002). Infection with A. fumigatus (n=7) was found in 2.4% of patients. In another study the incidence of positive Aspergillus cultures in kidney transplant recipients was similar at 2.2% (Brown et al, 1996), less than in liver transplant patients (4.5%). The mortality of the kidney transplant patients was 40%, similar to the mortality of the liver transplant patients (41%). A. fumigatus was the most frequently isolated Aspergillus species, occurring in 60% of kidney transplant recipients and 69% of liver transplant recipients. Most cultures in both transplant groups were isolated from the lungs. However, it was felt that the majority of those cultures, particularly those obtained from body fluids, and were not indicative of disease. Interestingly, the predominance of cultures were positive in the early post-transplant period (< 30 days), which is different than majority of cases of IA in hematopoietic stem cell transplant patients which occurs at a mean of approximately 100 days post-transplant. more... |