Zygomycosis in solid organ transplant recipients: a prospective, matched case-control study to assess risks for disease and outcome.

Abstract

BACKGROUND:

Clinical characteristics, risks, and outcomes in solid organ transplant (SOT) recipients with zygomycosis in the era of modern immunosuppressive and newer antifungal agent use have not been defined.

METHODS:

In a matched case-controlled study, SOT recipients with zygomycosis were prospectively studied. The primary outcome measure was success (complete or partial response) at 90 days.

RESULTS:

Renal failure (odds ratio [OR], 3.17; P = .010), diabetes mellitus (OR, 8.11; P < .001), and prior voriconazole and/or caspofungin use (OR, 4.41; P = .033) were associated with a higher risk of zygomycosis, whereas tacrolimus (OR, 0.23; P = .002) was associated with a lower risk of zygomycosis. Liver transplant recipients were more likely to have disseminated disease (OR, 5.48; P = .021) and developed zygomycosis earlier after transplantation than did other SOT recipients (median, 0.8 vs 5.7 months; P < .001). Overall the treatment success rate was 60%. Renal failure (OR, 11.3; P = .023) and disseminated disease (OR, 14.6; P = .027) were independently predictive of treatment failure, whereas surgical resection was associated with treatment success (OR, 33.3; P = .003). The success rate with liposomal amphotericin B was 4-fold higher even when controlling for the aforementioned variables.

CONCLUSIONS:

The risks identified for zygomycosis and for disseminated disease, including those that were previously unrecognized, have implications for further elucidating the biologic basis and for optimizing outcomes in SOT recipients with zygomycosis.

• Authors: Nina Singh, Jose M Aguado, Hugo Bonatti, Graeme Forrest, Krishan L Gupta, Nasia Safdar, George T John, Kenneth J Pursell, Patricia Muñoz, Robin Patel, Jesus Fortun, Pilar Martin-Davila, Bruno Philippe, François Philit, Alexis Tabah, Nicolas Terzi, Valérie Chatelet, Shimon Kusne, Nina Clark, Emily Blumberg, Marino Blanes Julia, Abhi Humar, Sally Houston, Cornelia Lass-Flörl, Leonard Johnson, Erik R Dubberke, Michelle A Barron, Olivier Lortholary
• Journal: The Journal of infectious diseases (J Infect Dis) Vol. 200 Issue 6 Pg. 1002-11 (Sep 15 2009) ISSN: 0022-1899 [Print] United States
• PMID: 19659439 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antifungal Agents
• Immunosuppressive Agents

Topics

• Aged
• Antifungal Agents (therapeutic use)
• Case-Control Studies
• Female
• Humans
• Immunocompromised Host
• Immunosuppressive Agents (pharmacology)
• Male
• Middle Aged
• Organ Transplantation (adverse effects)
• Postoperative Complications (microbiology)
• Prospective Studies
• Risk Factors
• Zygomycosis (epidemiology, etiology, prevention & control)