1094. Epidemiology, Timing, and Outcomes of Invasive Mould Infections among Transplant Recipients: a 10-Year, Single-Center Experience
Session: Poster Abstract Session: Infections After Solid Organ Transplants
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • IMI Transplant, Poster, IDSA 2011.pdf (568.4 kB)
  • Background: 

    Invasive mould infections (IMIs) are important in transplant recipients, and early indicators suggest that incidence, and outcomes of infections have changed over the last 15 years.   

    Methods: 

    We conducted a retrospective observational study on the epidemiology, timing, and outcomes of proven and probable IMIs -using established definitions- among all adult hematopoietic stem cell transplant (HSCT) and solid organ transplant (SOT) recipients at our institution between 2000 and 2009.     

    Results: 

    A total of 156 patients with one IMI were identified; 15 patients had 2 pathogens identified.  Invasive aspergillosis (IA) was the most common IMI observed (101; 64.7%), followed by zygomycosis (10; 6.4%).  The overall incidence of proven and probable IMIs during the study period was: 3.8%, 3.8%, 1.0%, 3.5%, and 39.2%, for allogeneic HSCT, heart, kidney, liver, and lung recipients, respectively.  The incidence of IA was: 2.5%, 1.9%, 0.6%, 2.3%, and 26.3% for allogeneic HSCT, heart, kidney, liver, and lung recipients, respectively.  More cases of IA were diagnosed among liver recipients (3.3% vs. 0.5%; P=0.04) and non-HLA matched related HSCT recipients (2.0% vs. 0.6%; P=0.04) between 2005-09 vs. 2000-04.  IMIs occurred later in heart (mean: 1257.7 days; P=0.001) compared to liver (mean: 64.8), kidney (mean: 373.7) and lung (mean: 257.8) post transplant.  The mean time to diagnosis of IMIs and IA in allogeneic HSCT recipients were 214.5 and 219.2 days, respectively.  Liver transplant recipients with IMIs were more likely to have died by 12 weeks (47.1%) compared to heart (16.7%), kidney (27.8%), and lung (7.5%) recipients (P=0.0008).  The overall 12-week mortality among allogeneic HSCT recipients with IMIs and IA was 52.4% and 42.9%, respectively, and it did not change over the time period.

    Conclusion: 

    A high incidence of IMIs was observed among lung transplant recipients, albeit with the lowest overall mortality, compared to other SOTs.  Liver transplant recipients tended to develop IMIs earlier and were more likely to die, compared to other SOT recipients.  We observed a lower than reported incidence of IMIs among allogeneic HSCT recipients with persistent high mortality rates.


    Subject Category: O. Transplant infectious diseases

    Dionissios Neofytos, MD, MPH1, Suzanne Treadway, RN, BSN2, Darin Ostrander, PhD3, Carolyn D. Alonso, M.D.2 and Kieren A. Marr, MD4, (1)Johns Hopkins, Baltimore, MD, (2)Medicine, The Johns Hopkins Hospital, Baltimore, MD, (3)The Johns Hopkins Hospital, Baltimore, MD, (4)Johns Hopkins University School of Medicine, Baltimore, MD

    Disclosures:

    D. Neofytos, Pfizer: Research Contractor, Research grant

    S. Treadway, None

    D. Ostrander, None

    C. D. Alonso, None

    K. A. Marr, Pfizer, Merck, Astellas: Consultant, Grant Investigator, Investigator and Scientific Advisor, Consulting fee, Grant recipient and Research grant
    Basilea, Schering Plough: Consultant and Scientific Advisor, Consulting fee

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