Trends in invasive disease due to Candida species following heart and lung transplantation

• Published in: Transplant infectious disease 2009-04, Vol.11 (2), p.112-121
• Main Authors: Schaenman, J.M., Rosso, F., Austin, J.M., Baron, E.J., Gamberg, P., Miller, J., Oyer, P.E., Robbins, R.C., Montoya, J.G.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Antifungal Agents - therapeutic use; California - epidemiology; Candida; Candida - classification; Candida - isolation & purification; candidiasis; Candidiasis - epidemiology; Candidiasis - etiology; Candidiasis - mortality; Candidiasis - prevention & control; Child; Child, Preschool; Cytomegalovirus; Databases, Factual; Female; heart transplantation; Heart Transplantation - adverse effects; heart-lung transplantation; Heart-Lung Transplantation - adverse effects; Humans; immunosuppression; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Incidence; Infant; Infant, Newborn; lung transplantation; Lung Transplantation - adverse effects; Male; Middle Aged; Postoperative Complications - epidemiology; Postoperative Complications - microbiology; Postoperative Complications - mortality; Postoperative Complications - prevention & control; Young Adult
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/j.1399-3062.2009.00364.x

: Although invasive candidiasis (IC) causes significant morbidity and mortality in patients who undergo heart, lung, or heart–lung transplantation, a systematic study in a large cohort of thoracic organ transplant recipients has not been reported to date. Clinical and microbiological data were reviewed for 1305 patients who underwent thoracic organ transplantation at Stanford University Medical Center between 1980 and 2004. We identified and analyzed 76 episodes of IC in 68 patients (overall incidence 5.2% per patient). The incidence of IC was higher in lung (LTx) and heart–lung transplant (HLTx) recipients as compared with heart transplant (HTx) recipients (risk ratio [RR] 1.7, 95% confidence interval [CI] 1.1–2.7). The incidence of IC decreased over time in all thoracic organ transplant recipients, decreasing from 6.1% in the 1980–1986 time period to 2.1% in the 2001–2004 era in the HTx recipients, and from 20% in the 1980–1986 period to 1.8% in the 2001–2004 period in the LTx and HLTx recipients. The most common site of infection differed between the HTx and LTx cohorts, with bloodstream or disseminated disease in the former and tracheobronchitis in the latter. IC in the first year after transplant was significantly associated with death in both HTx (RR 2.9, 95% CI 1.8–4.6, P=0.001) and LTx and HLTx patients (RR 3.0, 95% CI 1.9–4.6, P