1514. Differences in Epidemiological Features of Invasive Mould Infections Among Solid Organ Transplant Recipients: PATH Alliance Registry Analysis
Session: Poster Abstract Session: Infections and Transplantation
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • 1514 Husain IDWeek2013 PATH IFIs in SOTR Epidemiology.pdf (4.6 MB)
  • Background: Invasive mould infections (IMIs) are a major cause of morbidity and mortality in solid organ transplant recipients (SOTRs). However, unique epidemiological characteristics and outcomes among SOTRs have not been well defined in large, multicenter studies.

    Methods: The Prospective Antifungal Therapy (PATH) Alliance registry is an invasive fungal infection (IFI) network comprising 25 centers from the United States and Canada. Proven and probable IFIs (based on Mycosis Study Group criteria) were prospectively identified from July 1, 2004 to September 30, 2008.

    Results: During the surveillance period, 333 IMIs among SOTR were identified. The most common IMI was invasive aspergillosis (IA; 91%), followed by mucormycosis (7%). Liver transplant recipients (LTRs) had the highest rate of mucormycosis 24% (n=8/33). The lowest median time to onset of IMI was in LTRs (109 days: IQR 24611), while the longest was in lung transplant recipients (486 days: IQR 1171358). Disseminated IMIs were most common in LTRs (n=18/33; 55%). Of the 302 evaluable IMI patients, overall mortality at 12 weeks was 25% (n=76/302). Lung transplant recipients had the lowest mortality (n=31/184; 17%) while LTRs had the highest mortality (n=21/33; 64%) at 12 weeks (Figure). None of the 4 small bowel transplant recipients died at 12 weeks. Of those with a known outcome at week 12, complete or partial response in patients with IA was 67% (n=189/281) and 41% (n=9/22) in patients with mucormycosis. In the composite outcome of death or no response to therapy, LTRs had the worst outcome as shown below.

    Conclusion: These data identify the unique features of clinical presentation and higher mortality associated with IMI in LTRs. Higher suspicion of mould infection and institution of appropriate anti-fungal prophylactic strategies are warranted, especially in LTRs whom have very high fatality rates.

    Shahid Husain, MD1, Fernanda Silveira, MD, MS2, Nkechi Azie, MD3, Billy Franks, PhD3 and David Horn, MD4, (1)University of Toronto, Toronto, ON, Canada, (2)University of Pittsburgh, Pittsburgh, PA, (3)Astellas Scientific and Medical Affairs, Inc., Northbrook, IL, (4)David Horn, LLC, Doylestown, PA

    Disclosures:

    S. Husain, Astellas: Consultant and Grant Investigator, Consulting fee and Research grant
    Pfizer: Consultant and Grant Investigator, Consulting fee and Research grant
    Merck: Consultant and Grant Investigator, Consulting fee and Research grant

    F. Silveira, None

    N. Azie, Astellas: Employee, Salary

    B. Franks, Astellas: Employee, Salary

    D. Horn, David Horn LLC: Consultant, Consulting fee

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.