Incidence and risk factors for mucormycosis in renal transplant patients

AbstractBackgroundRenal transplant patients are at increased risk for mucormycosis. Diabetes, neutropenia, deferoxamine therapy, and immunosuppressive medications have been associated with increased risk of mucormycosis in studies of solid organ transplant recipients. To focus on renal transplant patients, the US Renal Data System (USRDS) was queried to determine the incidence and risk factors for mucormycosis.MethodsAll renal transplant patients in the USRDS from 1988 to 2015 were queried for a diagnosis of mucormycosis after the first transplant date using ICD-9 and ICD-10 codes. The International Classification of Diseases (ICD) codes, which currently exist in the ninth and tenth revisions, are a global system of classification used to code diagnoses, procedures, and symptoms. We defined proven mucormycosis by a histopathologic or fungal stain procedure code within 7 days of the diagnosis code. Logistic regression controlling for person-years at risk was used to examine demographic and clinical diagnosis risk factors for mucormycosis.ResultsOf the 306,482 renal transplant patients, 222 (0.07%) had codes consistent with proven mucormycosis. The incidence of mucormycosis increased from 1990 to 2000 (peak 17.6 per 100,000 person-years) and subsequently demonstrated more variability. Hispanic ethnicity (OR=1.45), age 65 years or greater (OR=1.64), other or black race compared with white race (OR=1.96 and 1.74), cadaver or other donor type (OR=2.41), and receiving tacrolimus (OR=2.09) were associated with increased risk. Comorbidities associated with decreased risk of mucormycosis included female sex (OR=0.68), iron overload (OR=0.56), and receiving mycophenolate mofetil (OR=0.67) or azathioprine (OR=0.53).ConclusionsIn renal transplant patients, age, deceased donor graft transplant, tacrolimus administration, race other than white, and Hispanic ethnicity were associated with increased risk of mucormycosis. Unexpectedly, iron overload was protective. Mucormycosis is a rare infection in renal transplant patients which should be considered in patients with the above risk factors after more common infections have been ruled out.

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Risk Factors and Consequences of Delayed Graft Function in Deceased Donor Renal Transplant Patients Receiving Antithymocyte Globulin Induction

Transplantation Journal ◽

10.1097/tp.0b013e31817ef190 ◽

2008 ◽

Vol 86 (2) ◽

pp. 313-320 ◽

Cited By ~ 39

Author(s):

Samir J. Patel ◽

Benjamin T. Duhart ◽

Amy G. Krauss ◽

Linda W. Moore ◽

Maria F. Egidi ◽

...

Keyword(s):

Risk Factors ◽

Renal Transplant ◽

Antithymocyte Globulin ◽

Graft Function ◽

Deceased Donor ◽

Delayed Graft Function ◽

Transplant Patients ◽

Renal Transplant Patients

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Administration of metformin in renal transplant patients with post-transplant diabetes mellitus

Journal of Renal Injury Prevention ◽

10.15171/jrip.2019.35 ◽

2019 ◽

Vol 8 (3) ◽

pp. 190-194

Author(s):

Masoumeh Asgharpour ◽

Seyed Hadi Mirhashemi ◽

Amirhesam Alirezaei

Keyword(s):

Diabetes Mellitus ◽

Renal Transplant ◽

Organ Transplant ◽

Immunosuppressive Drugs ◽

Solid Organ ◽

Kidney Transplant Recipients ◽

Post Transplant ◽

Control Blood Glucose ◽

Transplant Patients ◽

Renal Transplant Patients

Diabetes is the most common cause of renal failure which is frequently seen in candidates of solid organ transplant both before and after of the transplantation. For successful long-term tissue graft, it is important to control blood glucose level particularly after transplantation. Post-transplant diabetes mellitus (PTDM) is the main issue contributing to cardiovascularrelated mortality in kidney transplant recipients. Important risk factors of PTDM include using immunosuppressive drugs, post-transplant weight gain and obesity, and the presence of pre-transplant diabetes. Because of safety concerns, there has been a consensus from 2003 onward to cease metformin as the first-line anti-diabetic drug in patients with PTDM. The relationship between PTDM and metformin administration in high-risk renal transplant patients needs to be validated by more trial studies to establish the risk-benefit balance using this drug. Here, we reviewed the pros and cons of using metformin by presenting conclusions from several retrospective and clinical trial studies.

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Successfully Treated Norovirus- and Sapovirus-Associated Diarrhea in Three Renal Transplant Patients

Case Reports in Infectious Diseases ◽

10.1155/2018/6846873 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Noha Ghusson ◽

Gustavo Vasquez

Keyword(s):

Renal Transplant ◽

Therapeutic Option ◽

Organ Transplant ◽

Solid Organ ◽

Infectious Diarrhea ◽

Viral Diarrhea ◽

Viral Shedding ◽

Transplant Patients ◽

Duration Of Illness ◽

Renal Transplant Patients

Objectives. To examine the burden of norovirus- and sapovirus-related diarrhea in renal transplant patients and to propose the use of nitazoxanide as a therapeutic option for treatment. Methods. We reviewed three renal transplant patients with viral diarrhea requiring hospitalization due to acute renal failure and signs of graft rejection. All three patients were treated with nitazoxanide. We examined their clinical courses after therapy and compared time to resolution of symptoms and viral shedding. Results. In all three renal transplant patients, improvement of diarrheal illness was witnessed within one week of nitazoxanide initiation. Conclusions. Infectious diarrhea remains an underestimated yet significant cause of morbidity in solid organ transplant patients. Norovirus and sapovirus are often responsible for this presentation. Nitazoxanide was used as a treatment modality with success in reduction of symptoms, decreased duration of illness, and cessation of viral shedding.

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Nocardiosis in renal transplant patients

Journal of Investigative Medicine ◽

10.1136/jim-2021-001783 ◽

2021 ◽

pp. jim-2021-001783

Author(s):

Maya Gibson ◽

Nianlan Yang ◽

Jennifer L Waller ◽

Lufei Young ◽

Wendy B Bollag ◽

...

Keyword(s):

Risk Factors ◽

Renal Transplant ◽

Brain Abscess ◽

Graft Failure ◽

Factors Associated ◽

Transplant Patients ◽

Allograft Failure ◽

Increased Risk ◽

History Of ◽

Renal Transplant Patients

Renal transplant patients are immunosuppressed and are at increased risk of opportunistic infections, including Nocardia infection. In renal transplant patients, information on the incidence and risk factors associated with nocardiosis is limited. To address the incidence and risk factors associated with nocardiosis in a large renal transplant population, we used the US Renal Data System (USRDS). Sequelae of allograft failure or rejection after infection were also examined. Demographics, clinical risk factors, Nocardia diagnosis, and allograft failure following Nocardia infection were queried in USRDS renal transplant patients using International Classification of Diseases, Ninth Revision (ICD-9) codes in billing claims and Centers for Medicare and Medicaid Services Form 2728. Generalized linear models were used to determine the risk factors associated with nocardiosis, and Cox proportional hazards models were used to examine the association of risk factors with graft failure among patients with Nocardia infection. Of 203,233 renal transplant recipients identified from 2001 to 2011, 657 (0.32%) were diagnosed with Nocardia infection. Pneumonia was the most frequent presentation (15.2%), followed by brain abscess (8.4%). Numerous factors associated with increased Nocardia infection included age >65 years (OR=2.10, 95% CI 1.71 to 2.59), history of transplant failure (OR=1.28, CI 1.02 to 1.60) or history of rejection (OR=4.83, CI 4.08 to 5.72), receipt of a deceased donor transplant (OR=1.23, CI 1.03 to 1.46), and treatment with basiliximab (OR=1.25, CI 1.00 to 1.55), cyclosporine (OR=1.30, CI 1.03 to 1.65), tacrolimus (OR=2.45, CI 2.00 to 3.00), or thymoglobulin (OR=1.89, CI 1.59 to 2.25). In patients with nocardiosis administration of antithymocyte globulin (HR=2.76), chronic obstructive pulmonary disease (HR=2.47), and presentation of Nocardia infection with brain abscess (HR=1.85) were associated with an increased risk of graft failure. This study provides new information to enhance early recognition and targeted treatment of nocardiosis in renal transplant patients.

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