COMPLICATIONS - INFECTIONS

G. Chen¹, Z. Zhang¹, C. Wang², J. Qiu¹, J. Fei¹, S. Deng¹, J. Li¹, G. Huang¹, Q. Fu¹, L. Zhang¹, L. Chen^3
1Organ Transplant Center, 1st affiliated hospital of Sun Yat-Sen University, Guangzhou/CHINA, ²Department Of Organ Transplantation, First Affiliated Hospital, Sun Yat-sen University, Guangzhou/CHINA, ³Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou/CHINA

Body:
Introduction Pulmonary mycosis is a severe complication following kidney transplantation and is associated with a high rate of mortality. The incidence and independent risk factors for its development has not been well studied. Methods We retrospectively reviewed 2573 kidney recipients, who underwent transplantation in our center from Jan 1994 to May 2008 to determine the incidence of pulmonary mycosis. Patients were divided into case and control groups based on a diagnosis of pulmonary mycosis or not. The recipients’ baseline characteristics, complications after transplant, immunosuppressive regimen and antibiotic usage were analyzed by single and multivariate analysis to identify independent risk factors for pulmonary mycosis. Results The total incidence of pulmonary mycosis in kidney recipients was 2.1%, with the majority (86.8%) developing it within the first year after transplant (median time, 72 days). The most common pathogen was Candida albicans（51.8%）. By univariate analysis, patients in the case group differed significantly from the control group by the following: older age, higher retransplantation rates, longer dialysis time, received induction with ATG and anti-CD25, FK506, MMF, broad-spectrum antibiotics, higher incidences of acute rejection, DGF, impaired liver function, leucopenia, CMV infection, and delayed incision healing (P<0.05). Multivariate analysis showed that age, retransplantation, ATG induction, FK506, MMF, broad-spectrum antibiotics, leucopenia, and delayed incision healing were independent risk factors for pulmonary mycosis. Patients who received CsA+Aza had the lowest morbidity rate of pulmonary mycosis (0.49%), whereas FK506+MMF group had the highest morbidity rate(3.88%,Log-rank = 20.3, P<0.001). The morbidity rate increased from 0.45% to 13.79% when independent risk factors increased from 1 to 5 or more (P<0.001).Conclusions: The usage of a more potent immunosuppressive regimenseems to increase the rate of pulmonary mycosis. Patients who have 5 or more independent risk factors are at high risk for developing pulmonary mycosis, and anti-fungal prophylaxis may be warrantedin these patients.

Disclosure: All authors have declared no conflicts of interest.