Study of systemic fungal infections in renal transplant recipients

Background: Despite technical, immunological, and therapeutic advances in the field of renal transplantation, infections remain a major barrier to successful outcome. Fungal infections (14%) after renal transplantation, despite a lower incidence than bacterial and viral infections, remain a major cause of morbidity and mortality. This study was conducted to assess the impact of invasive fungal infections in our renal transplant recipients. Aim: To study the clinical profile, risk factors for acquiring fungal infections, its outcome and the factors influencing outcome in living and deceased donor renal transplant recipients. Materials and methods: Renal transplant recipients both cadaveric and living-related during the time period between August 2008 and May 2011 admitted with systemic fungal infections in nephrology ward were included in the study. Data gathered included age, sex, date of transplantation, date of diagnosis, fungal pathogen, organs affected by infection, treatment and patient outcome. Microsoft excel 2007, Binomial and Student t tests were used for statistical analysis. Observation: Twenty two patients were diagnosed with systemic fungal infections during this period. The mean age of the study patients was 35.55 years. The male to female ratio was 1.75:1.Candida species (62%) are the commonest organisms causing fungal infection. Fungal infections commonly occurred in gastrointestinal tract (GIT), lung and urinary tract, each 22%. Fifty percent of patients with fungal infections expired. Graft loss occurred in 41% of patients. Conclusion: The mortality rate was 50%. Bone marrow suppression {Leukopenia (50%)} and hypoalbuminemia (59%) contributed to high mortality. Overall immunosuppression should be monitored periodically and kept at optimal level just enough to avoid rejection, thereby avoiding opportunistic infections.