Risk factors for intra-abdominal fungal infection after simultaneous pancreas-kidney transplantation: A single-center retrospective experience.
Candida peritonitis
fungal peritonitis
invasive candidiasis
invasive fungal infection
pancreas-kidney transplantation
Journal
Transplant infectious disease : an official journal of the Transplantation Society
ISSN: 1399-3062
Titre abrégé: Transpl Infect Dis
Pays: Denmark
ID NLM: 100883688
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
revised:
17
08
2020
received:
24
03
2020
accepted:
20
09
2020
pubmed:
14
10
2020
medline:
3
8
2021
entrez:
13
10
2020
Statut:
ppublish
Résumé
Data on the risk factors and outcome of intra-abdominal fungal infections (IAFI) following simultaneous pancreas-kidney transplantation (PKT) are scarce. A retrospective monocentric study was conducted on all patients who underwent simultaneous PKT from January 2007 to December 2016. Deep sites positive cultures for fungi during the first post-transplantation year were collected. Clinical, radiological, and microbiological data of proven and probable invasive fungal infections were analysed. Among sixteen PKT patients, 15 were included. Seven patients (47%) developed an invasive fungal infection, exclusively IAFI (six proven, one probable). The proven IAFI included four peritonitis, one pancreatic necrosis with infected hematoma, and one patient with positive preservation fluid only (PF). Candida albicans (n = 4) was the most prevalent species (associated with Galactomyces candidus in one case), C glabrata, C dubliniensis, and C krusei were found in one case each. Three patients had either a positive direct examination and/or culture for renal or pancreatic PF and the culture of PF was positive for the same species that caused IAFI. IAFIs were significantly associated with pancreatic graft arterial thrombosis (5/7 vs 0/8, P = .007) and fungal contamination of PF (3/7 vs 0/8, P = .008). Among patients with IAFI, all required an early surgical revision post-transplantation [1-18 days] and six had early or delayed pancreatic graft removal. One patient died in the first post-transplant year. IAFI is a common complication in PKT, associated with pancreatic graft thrombosis or fungal contamination of the graft PF, and can sometimes lead to pancreatic detransplantation.
Sections du résumé
BACKGROUND
BACKGROUND
Data on the risk factors and outcome of intra-abdominal fungal infections (IAFI) following simultaneous pancreas-kidney transplantation (PKT) are scarce.
MATERIALS/METHODS
METHODS
A retrospective monocentric study was conducted on all patients who underwent simultaneous PKT from January 2007 to December 2016. Deep sites positive cultures for fungi during the first post-transplantation year were collected. Clinical, radiological, and microbiological data of proven and probable invasive fungal infections were analysed.
RESULTS
RESULTS
Among sixteen PKT patients, 15 were included. Seven patients (47%) developed an invasive fungal infection, exclusively IAFI (six proven, one probable). The proven IAFI included four peritonitis, one pancreatic necrosis with infected hematoma, and one patient with positive preservation fluid only (PF). Candida albicans (n = 4) was the most prevalent species (associated with Galactomyces candidus in one case), C glabrata, C dubliniensis, and C krusei were found in one case each. Three patients had either a positive direct examination and/or culture for renal or pancreatic PF and the culture of PF was positive for the same species that caused IAFI. IAFIs were significantly associated with pancreatic graft arterial thrombosis (5/7 vs 0/8, P = .007) and fungal contamination of PF (3/7 vs 0/8, P = .008). Among patients with IAFI, all required an early surgical revision post-transplantation [1-18 days] and six had early or delayed pancreatic graft removal. One patient died in the first post-transplant year.
CONCLUSION
CONCLUSIONS
IAFI is a common complication in PKT, associated with pancreatic graft thrombosis or fungal contamination of the graft PF, and can sometimes lead to pancreatic detransplantation.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13486Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Grochowiecki T, Gałązka Z, Madej K, et al. Surgical Complications Related to Transplanted Pancreas After Simultaneous Pancreas and Kidney Transplantation. Transplant P. 2014;46(8):2818-2821. https://doi.org/10.1016/j.transproceed.2014.08.012
Michalak G, Kwiatkowski A, Czerwinski J, et al. Surgical Complications of Simultaneous Pancreas-Kidney Transplantation: A 16-Year-Experience at One Center. Transplant P. 2005;37(8):3555-3557. https://doi.org/10.1016/j.transproceed.2005.09.077
Herrero-Martínez JM, Lumbreras C, Manrique A, et al. Epidemiology, risk factors and impact on long-term pancreatic function of infection following pancreas-kidney transplantation. Clin Microbiol Infect. 2013;19(12):1132-1139. https://doi.org/10.1111/1469-0691.12165
Hosseini-Moghaddam SM, Ouédraogo A, Naylor KL, et al. Incidence and outcomes of invasive fungal infection among solid organ transplant recipients: A population-based cohort study. Transpl Infect Dis. 2020;25:e13250. https://doi.org/10.1111/tid.13250
Pappas P, Alexander B, Andes D, et al. Invasive fungal infections among organ transplant recipients: Results of the transplant-associated infection surveillance network (TRANSNET). Clin Infect Dis. 2010;50(8):1101-1111. https://doi.org/10.1086/651262
Botterel F, Foulet F, Legrand P, et al. Yeast contamination of kidney, liver and cardiac preservation solutions before graft: need for standardisation of microbial evaluation. J Hosp Infect. 2010;76(1):52-55. https://doi.org/10.1016/j.jhin.2010.02.008
Canaud G, Timsit M-O, Zuber J, et al. Early conservative intervention for candida contamination of preservative fluid without allograft nephrectomy. Nephrol Dial Transpl. 2009;24(4):1325-1327. https://doi.org/10.1093/ndt/gfn622
Matignon M, Botterel F, Audard V, et al. Outcome of renal transplantation in eight patients with Candida sp. contamination of preservation fluid. Am J Transplant. 2008;8(3):697-700. https://doi.org/10.1111/j.1600-6143.2007.02112.x
Albano L, Bretagne S, Mamzer-Bruneel M-F, et al. Evidence that graft-site candidiasis after kidney transplantation is acquired during organ recovery: a multicenter study in France. Clin Infect Dis. 2009;48(2):194-202. https://doi.org/10.1086/595688
Rodrigues BF, Natário AS, Vizinho RS, et al. Candida Species Contamination of Preservation Fluid-Outcome of Renal Transplantation in 6 Patients. Transplant P. 2013;45(6):2215-2219. https://doi.org/10.1016/j.transproceed.2013.03.024
Veroux M, Corona D, Scriffignano V, et al. Contamination of preservation fluid in kidney transplantation: single-center analysis. Transplant P. 2010;42(4):1043-1045. https://doi.org/10.1016/j.transproceed.2010.03.041
Benedetti E, Gruessner A, Troppmann C, et al. Intra-abdominal fungal infections after pancreatic transplantation: incidence, treatment, and outcome. J Am Coll Surgeons. 1996;183(4):307-316.
Donnelly P, Chen S, Kauffman C, et al. Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin Infect Dis. 2020;71(6):1367-1376. https://doi.org/10.1093/cid/ciz1008
Gavaldà J, Meije Y, Fortún J, et al. ESCMID Study Group for Infections in Compromised Hosts. Invasive fungal infections in solid organ transplant recipients. Clin Microbiol Infect. 2014;20(S7):27-48. https://doi.org/10.1111/1469-0691.12660
de Biomédecine A. Prévention de la transmission de bactéries et d’agents fongiques aux receveurs d’organes. Septembre: Recommandations professionnelles; 2008. https://www.agence-biomedecine.fr/IMG/pdf/prevention-de-la-transmission-de-bacteries-et-d-agents-fongiques-aux-receveurs-d-organes-texte-long.pdf
Andes DR, Safdar N, Baddley JW, et al. The epidemiology and outcomes of invasive Candida infections among organ transplant recipients in the United States: results of the Transplant-Associated Infection Surveillance Network (TRANSNET). Transpl Infect Dis Official J Transplant Soc. 2016;18(6):921-931. https://doi.org/10.1111/tid.12613
Humar A, Kandaswamy R, Granger D, Gruessner RW, Gruessner AC, Sutherland DE. Decreased Surgical Risks of Pancreas Transplantation in the Modern Era. Ann Surg. 2000;231(2):269-275. https://doi.org/10.1097/00000658-200002000-00017
Gilabert R, Fernández-Cruz L, Real M, Ricart M, Astudillo E, Montaña X. Treatment and outcome of pancreatic venous graft thrombosis after kidney-pancreas transplantation. Brit J Surg. 2002;89(3):355-360. https://doi.org/10.1046/j.0007-1323.2001.02016.x
Dinckan A, Aliosmanoglu I, Kocak H, et al. Pancreas survival in simultaneous pancreas-kidney and pancreas-after-kidney transplantations: a five-year follow-up report. Ann Transpl. 2012;17(3):14-19. https://doi.org/10.12659/aot.883453
Okabe Y, Kitada H, Miura Y, et al. Pancreas transplantation: a single-institution experience in Japan. Surg Today. 2013;43(12):1406-1411. https://doi.org/10.1007/s00595-013-0516-6
Hakeem A, Chen J, Iype S, et al. Pancreatic allograft thrombosis: Suggestion for a CT grading system and management algorithm. Am J Transplant. 2018;18(1):163-179. https://doi.org/10.1111/ajt.14433
Rudolph EN, Dunn TB, Sutherland DE, Kandaswamy R, Finger EB. Optimizing outcomes in pancreas transplantation: Impact of organ preservation time. Clin Transplant. 2017;31(9):e13035. https://doi.org/10.1111/ctr.13035
Levesque E, Paugam-Burtz C, Saliba F, et al. Fungal complications after Candida preservation fluid contamination in liver transplant recipients. Transplant Int. 2015;28(11):1308-1316. https://doi.org/10.1111/tri.12633
Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62(4):e1-e50. https://doi.org/10.1093/cid/civ933
Aslam S, Rotstein C, the of Practice A. Candida infections in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;33(9): https://doi.org/10.1111/ctr.13623
Parajuli S, Arunachalam A, Swanson KJ, et al. Outcomes after simultaneous kidney-pancreas versus pancreas after kidney transplantation in the current era. Clin Transplant. 2019. https://doi.org/10.1111/ctr.13732
Martins L, Henriques A, Dias L, et al. Pancreas-kidney transplantation: Complications and readmissions in 9-years of follow-up. Transplant P. 2010;42(2):552-554. https://doi.org/10.1016/j.transproceed.2010.01.043
Shaikh SA, Zimmerman A, Nolan A, et al. The Incidence of Fungal Infections in Pancreas Transplant Recipients in the Absence of Systemic Antifungal Prophylaxis. Clin Transplant. 2019;33(10):e1369. https://doi.org/10.1111/ctr.13691
Ait-Ammar N, Levesque E, Marie M, et al.Candida contamination of liver, kidney and heart preservation fluids: a ten-year monocentric retrospective study. 26th European Congress for Clinical Microbiology and Infectious Diseases (ECCMID) Amsterdam, Netherlands, 10-12 April 2016. P5625.