Invasive fungal infections in renal allograft recipients.

ABSTRACT

Invasive fungal infections contribute significantly to morbidity and mortality in renal allograft recipients. We identified 29 cases of invasive mycoses on histological and/or cytological examination, out of the total 1231 renal transplants performed at our centre over a period of last 15 yrs (1989-2003). A detailed clinical analysis was performed. The time interval between transplant and the occurrence of invasive fungal infection ranged from 15 days to 10.5 yrs. Candida and Aspergillus were the most frequent offenders (66%); Candida alone accounting for 45% of the cases. The most common risk factors were post transplant Cytomegalovirus infection, diabetes mellitus and episodes of acute rejection. Fine needle aspiration cytology, bronchoalveolar lavage and esophageal brush smears aided in prompt diagnosis. Disseminated infection was associated with a high mortality (80%). Management of renal transplant recipients requires identification of risk factors and early clinical suspicion of infection. The role of prophylaxis needs further evaluation.