1092. The Changing Epidemiology of Invasive Fungal Infections in Solid Organ Transplant Recipients: Is the West like the rest?
Session: Poster Abstract Session: Infections After Solid Organ Transplants
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Invasive fungal infections (IFIs) are a significant cause of morbidity and mortality among solid organ transplant recipients. Studies that analyze disease burden and trends have largely focused on transplant centers in the Eastern United States. Given the geographic variability in fungal epidemiology and the relative under-representation of West coast sites in the published data, we seek to characterize the pathogen-specific incidence of IFIs in solid organ transplant patients at UCSF.

Methods: The UCSF TITUS database (maintained by the Department of Surgery, Division of Transplantation), comprises patients admitted for heart, lung, kidney, kidney-pancreas, small bowel and liver transplantation between 2000 to 2010. We performed retrospective analysis of solid organ transplant recipients to identify IFIs within this population. To explore trends, we calculated 1-year cumulative incidence.

Results: Among a cohort of 4002 patients who underwent transplantation between January 2000 and December 2008, 211 IFIs were identified among 149 organ recipients. The most prevalent IFIs were invasive aspergillosis (47.9%), invasive candidiasis (27.5%), non-Aspergillus moulds (10.4%),  zygomycosis (6.6%), cryptococcosis (4.7%) and endemic fungi (2.8%). Median time to diagnosis of aspergillosis, candidiasis, non-Aspergillus moulds, zygomycosis, cryptococcosis and endemic fungi was 38, 32, 25, 78, 159 and 153 weeks, respectively. One-year cumulative incidence of the first IFI was 30.3%, 9.3%, 3.3%, 1.7% and 1.4% for lung, heart, liver, pancreas and kidney transplant recipients, respectively. One-year incidence was the highest for invasive aspergillosis (1.5%) and invasive candidiasis (0.9%). Cumulative incidence showed a slight decrease from 2000 to 2008.

Conclusion: We detected a greater prevalence and cumulative incidence of invasive aspergillosis than reported by similar studies conducted in other regions of the United States. Cumulative incidence of IFIs in lung transplant recipients represents the largest burden of disease. These data highlight the geographic variability of IFIs and the need for region specific prophylaxis and treatment strategies.


Subject Category: O. Transplant infectious diseases

Farnaz Azarbal1, Mehdi Tavakol, MD2, James Hong1, John Roberts, MD2 and Peter Chin-Hong, MD1, (1)Internal Medicine, Division of Infectious Disease, University of California at San Francisco, San Francisco, CA, (2)Department of Surgery, University of California at San Francisco, San Francisco, CA

Disclosures:

F. Azarbal, None

M. Tavakol, None

J. Hong, None

J. Roberts, None

P. Chin-Hong, None

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