Journal Article

Invasive Fungal Infections among Organ Transplant Recipients: Results of the Transplant-Associated Infection Surveillance Network (TRANSNET)

Pappas, Peter G., Schuster, Mindy G., Wannemuehler, Kathleen A., Morrison, Vicki A., Walker, Randall, Hadley, Susan, Alexander, Barbara D., Anaissie, Elias J., Herwaldt, Loreen, Walsh, Thomas J., Andes, David R., Ito, James, Kontoyiannis, Dimitrios P., Marr, Kieren A., Brumble, Lisa M., Park, Benjamin J., Chiller, Tom M., Patterson, Thomas F., Freifeld, Alison, Kauffman, Carol A., Oster, Robert A., Perl, Trish M., Lyon, G. Marshall

2010

Overview

Background. Invasive fungal infections (IFIs) are a major cause of morbidity and mortality among organ transplant recipients. Multicenter prospective surveillance data to determine disease burden and secular trends are lacking. Methods. The Transplant-Associated Infection Surveillance Network (TRANSNET) is a consortium of 23 US transplant centers, including 15 that contributed to the organ transplant recipient dataset. We prospectively identified IFIs among organ transplant recipients from March, 2001 through March, 2006 at these sites. To explore trends, we calculated the 12-month cumulative incidence among 9 sequential cohorts. Results. During the surveillance period, 1208 IFIs were identified among 1063 organ transplant recipients. The most common IFIs were invasive candidiasis (53%), invasive aspergillosis (19%), cryptococcosis (8%), non-Aspergillus molds (8%), endemic fungi (5%), and zygomycosis (2%). Median time to onset of candidiasis, aspergillosis, and cryptococcosis was 103, 184, and 575 days, respectively. Among a cohort of 16,808 patients who underwent transplantation between March 2001 and September 2005 and were followed through March 2006, a total of 729 IFIs were reported among 633 persons. One-year cumulative incidences of the first IFI were 11.6%, 8.6%, 4.7%, 4.0%, 3.4%, and 1.3% for small bowel, lung, liver, heart, pancreas, and kidney transplant recipients, respectively. One-year incidence was highest for invasive candidiasis (1.95%) and aspergillosis (0.65%). Trend analysis showed a slight increase in cumulative incidence from 2002 to 2005. Conclusions. We detected a slight increase in IFIs during the surveillance period. These data provide important insights into the timing and incidence of IFIs among organ transplant recipients, which can help to focus effective prevention and treatment strategies.

• Publisher: The University of Chicago Press,University of Chicago Press,Oxford University Press
• Subject: Adolescent / Adult / Aged / Aged, 80 and over / ARTICLES AND COMMENTARIES / Aspergillosis / Aspergillus / Biological and medical sciences / Blood & organ donations / Child / Child, Preschool / Cohort Studies / Cryptococcosis / Female / Fungal infections / Humans / Immunocompromised Host / Incidence / Infant / Infections / Infectious diseases / Invasive candidiasis / Kidney transplantation / Lungs / Male / Medical sciences / Middle Aged / Mold / Mycoses - epidemiology / Prospective Studies / Sentinel Surveillance / Surveillance / Transplantation / Transplants & implants / Transplants - adverse effects / United States - epidemiology / Young Adult