Handling of Fungal Infections in Patients with Chronic Immunosuppression Post Renal Transplant
Invasive fungal infections (IFI) are serious diagnostics-therapeutic problem in recipients of vascularised organs. The nature of the IFI is determined by the type of the transplanted organ. Invasive candidiasis mostly occurs in liver recipients and invasive aspergilosis – in lung recipients. The greatest risk of IFI is in recipients of simultaneous lung and heart and liver transplants. Morbidity for IFI in the first year after transplantation is estimated to be in recipients of heart and lungs 8.6%, liver 4.7%, pancreas and kidneys 4% and heart 3.4%. Incidents of IFI among kidney recipients is estimated by differed sources to lay between 0.01 – 1.5%. Although, IFI occur rarely in kidney recipients in comparison to recipients of other organs, invasive fungal infections carries a high risk of graft loss and high mortality in this population of patients. Among recipients which have developed an IFI the risk of graft loss was determined in approx. 50% of patients, and mortality in this group was approx. 15%. Yearly survival of patients after an episode of invasive aspergilosis is 59%, for mycosis caused by mould fungi from species other then Aspergillus sp. 61%, invasive candidosis 66%, cryptococcosis 73%. There is definitely a greater risk for recipients of kidneys collected from cadavers, compared to living donors related to the recipient, respectively 16.5% and 7.3%. Additionally in cases of a deceased donor there is a high transfer risk for yeast-like fungi colonising in the urinary tract of a terminal state patient, in result of the breakdown of the defensive mechanism and contamination of preservative fluids, to the uninfected recipient. Mortality is determined by the virulence of the microorganism, localisation of the infection, weakened inflammatory response of the macroorganism, frequent co-occurring of renal insufficiency and diabetes and other predisposing factors. Unspecific clinical symptoms, fast progression of the disease and, what appears to be particularly important, lack of a precisely set algorithms of diagnostic procedure, contribute to the fact that IFI in kidney recipients are a diagnostics challenge and has a questionable therapeutic result.