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2015 ; 7
(6
): 371-8
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Fungal infections in renal transplant patients
#MMPMID25883698
Khan A
; El-Charabaty E
; El-Sayegh S
J Clin Med Res
2015[Jun]; 7
(6
): 371-8
PMID25883698
show ga
Organ transplantation has always been considered to be the standard therapeutic
interventions in patients with end-stage organ failure. In 2008, more than 29,000
organ transplants were performed in US. Survival rates among transplant
recipients have greatly improved due to better understanding of transplant
biology and more effective immunosuppressive agents. After transplant, the extent
of the immune response is influenced by the amount of interleukin 2 (IL-2) being
produced by the T-helper cells. Transplant immunosuppressive therapy primarily
targets T cell-mediated graft rejection. Calcineurin inhibitor, which includes
cyclosporine, pimecrolimus and tacrolimus, impairs calcineurin-induced
up-regulation of IL-2 expression, resulting in increased susceptibility to
invasive fungal diseases. This immunosuppressive state allows infectious
complication, leading to a high mortality rate. Currently, overall mortality due
to invasive fungal infections (IFIs) in solid organ transplant recipients ranges
between 25% and 80%. The risk of IFI following renal transplant is associated
with the dosage of immunosuppressive agents given, environmental factors and
post-transplant duration. Most fungal infections occur in the first 6 months
after transplant because of the use of numerous immunosuppressors. Candida spp.
and Cryptococcus spp. are the yeasts most frequently isolated, while most
frequent filamentous fungi (molds) isolated are Aspergillus spp. The symptoms of
systemic fungal infections are non-specific and early detection of fungal
infections and proper therapy are important in improving survival and reducing
mortality. This article will provide an insight on the risk factors and clinical
presentation, compare variation in treatment of IFIs in renal transplant
patients, and evaluate the role of prophylactic therapy in this group of
patients. We also report the course and management of two renal transplant
recipients admitted to Staten Island University Hospital, both of whom developed
pulmonary complications secondary to Aspergillus infection.
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