Epidemiology of systemic mycoses among renal-transplant recipients in India

George Tharayil John, Shankar Viswanathan, Girish Talaulikar, Mary S. Mathews, Mookanottle Abraham Abraham, Paulose Punnakuzhathil Thomas, Chakko Korula Jacob

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Background. Systemic mycoses have a high impact on tropical renal-transplant recipients. Methods. Data from 1,476 primary renal-transplant recipients was prospectively recorded from 1986 to 2000 at a single center. Cumulative incidence of systemic mycoses, its time of occurrence, risk factors, outcome, and postmortem findings in 30 patients with systemic mycoses were analyzed. Results. A total of 110 episodes of systemic mycoses occurred in 98 patients. The fungal genera Aspergillus, Cryptococcus, and Candida constituted 61% of pathogens, 45% localizing to the lungs. Cytomegalovirus (CMV) disease caused a 5-fold and chronic liver disease a 2-fold increase in systemic mycoses. Tuberculosis (TB) with or without nocardiosis was a significant coinfection. Cyclosporine (CsA) was associated with nearly a 4-fold risk of systemic mycoses less than 6 months from the time of transplantation as compared with prednisolone+azathioprine (PRED+AZA) therapy. Overall, the probability of survival with systemic mycoses was 73.4%, 60.8%, 39.5%, and 25.6% and was 92.5%, 87.5%, 80.0%, and 75.5% without systemic mycoses at 1, 2, 5, and 10 years, respectively (P<0.0001). An extended Cox model with time-independent and dependent covariates showed greater than 15 times the risk of death among those who develop systemic mycoses. Similarly, Posttransplantation (postTX) TB±Nocardiosis, preTX TB, CMV disease, diabetes mellitus, PTDM, chronic liver disease (>40 months), and Pred+AZA immunosuppression (>2 years) had 3.5, 1.5, 2.9, 1.9, 1.4, 1.6, 2.3 times the risk for death, respectively, as compared with those who did not have those risk factors. Conclusions. There is a recent predominance of Aspergillus among the transplant recipients. The risk factors for systemic mycoses are CMV disease, chronic liver disease, and hyperglycemia, and TB is an important coinfection. Systemic mycoses increased in the early postTX period with CsA. The risk factors for death are systemic mycoses, CMV disease, chronic liver disease (>40 months), diabetes mellitus, and Pred+AZA immunosuppression (>2 years). Overall, the probability of survival with systemic mycoses was poor; however, survival has recently improved.

Original languageEnglish (US)
Pages (from-to)1544-1551
Number of pages8
JournalTransplantation
Volume75
Issue number9
DOIs
StatePublished - May 15 2003
Externally publishedYes

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Mycoses
India
Epidemiology
Kidney
Cytomegalovirus
Liver Diseases
Chronic Disease
Aspergillus
Coinfection
Immunosuppression
Survival
Transplant Recipients
Tuberculosis
Nocardia Infections
Cryptococcus
Azathioprine
Prednisolone
Candida
Hyperglycemia
Cyclosporine

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

John, G. T., Viswanathan, S., Talaulikar, G., Mathews, M. S., Abraham, M. A., Thomas, P. P., & Jacob, C. K. (2003). Epidemiology of systemic mycoses among renal-transplant recipients in India. Transplantation, 75(9), 1544-1551. https://doi.org/10.1097/01.TP.0000061610.34110.04

Epidemiology of systemic mycoses among renal-transplant recipients in India. / John, George Tharayil; Viswanathan, Shankar; Talaulikar, Girish; Mathews, Mary S.; Abraham, Mookanottle Abraham; Thomas, Paulose Punnakuzhathil; Jacob, Chakko Korula.

In: Transplantation, Vol. 75, No. 9, 15.05.2003, p. 1544-1551.

Research output: Contribution to journalArticle

John, GT, Viswanathan, S, Talaulikar, G, Mathews, MS, Abraham, MA, Thomas, PP & Jacob, CK 2003, 'Epidemiology of systemic mycoses among renal-transplant recipients in India', Transplantation, vol. 75, no. 9, pp. 1544-1551. https://doi.org/10.1097/01.TP.0000061610.34110.04
John, George Tharayil ; Viswanathan, Shankar ; Talaulikar, Girish ; Mathews, Mary S. ; Abraham, Mookanottle Abraham ; Thomas, Paulose Punnakuzhathil ; Jacob, Chakko Korula. / Epidemiology of systemic mycoses among renal-transplant recipients in India. In: Transplantation. 2003 ; Vol. 75, No. 9. pp. 1544-1551.
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abstract = "Background. Systemic mycoses have a high impact on tropical renal-transplant recipients. Methods. Data from 1,476 primary renal-transplant recipients was prospectively recorded from 1986 to 2000 at a single center. Cumulative incidence of systemic mycoses, its time of occurrence, risk factors, outcome, and postmortem findings in 30 patients with systemic mycoses were analyzed. Results. A total of 110 episodes of systemic mycoses occurred in 98 patients. The fungal genera Aspergillus, Cryptococcus, and Candida constituted 61{\%} of pathogens, 45{\%} localizing to the lungs. Cytomegalovirus (CMV) disease caused a 5-fold and chronic liver disease a 2-fold increase in systemic mycoses. Tuberculosis (TB) with or without nocardiosis was a significant coinfection. Cyclosporine (CsA) was associated with nearly a 4-fold risk of systemic mycoses less than 6 months from the time of transplantation as compared with prednisolone+azathioprine (PRED+AZA) therapy. Overall, the probability of survival with systemic mycoses was 73.4{\%}, 60.8{\%}, 39.5{\%}, and 25.6{\%} and was 92.5{\%}, 87.5{\%}, 80.0{\%}, and 75.5{\%} without systemic mycoses at 1, 2, 5, and 10 years, respectively (P<0.0001). An extended Cox model with time-independent and dependent covariates showed greater than 15 times the risk of death among those who develop systemic mycoses. Similarly, Posttransplantation (postTX) TB±Nocardiosis, preTX TB, CMV disease, diabetes mellitus, PTDM, chronic liver disease (>40 months), and Pred+AZA immunosuppression (>2 years) had 3.5, 1.5, 2.9, 1.9, 1.4, 1.6, 2.3 times the risk for death, respectively, as compared with those who did not have those risk factors. Conclusions. There is a recent predominance of Aspergillus among the transplant recipients. The risk factors for systemic mycoses are CMV disease, chronic liver disease, and hyperglycemia, and TB is an important coinfection. Systemic mycoses increased in the early postTX period with CsA. The risk factors for death are systemic mycoses, CMV disease, chronic liver disease (>40 months), diabetes mellitus, and Pred+AZA immunosuppression (>2 years). Overall, the probability of survival with systemic mycoses was poor; however, survival has recently improved.",
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AU - Viswanathan, Shankar

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AU - Mathews, Mary S.

AU - Abraham, Mookanottle Abraham

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AU - Jacob, Chakko Korula

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N2 - Background. Systemic mycoses have a high impact on tropical renal-transplant recipients. Methods. Data from 1,476 primary renal-transplant recipients was prospectively recorded from 1986 to 2000 at a single center. Cumulative incidence of systemic mycoses, its time of occurrence, risk factors, outcome, and postmortem findings in 30 patients with systemic mycoses were analyzed. Results. A total of 110 episodes of systemic mycoses occurred in 98 patients. The fungal genera Aspergillus, Cryptococcus, and Candida constituted 61% of pathogens, 45% localizing to the lungs. Cytomegalovirus (CMV) disease caused a 5-fold and chronic liver disease a 2-fold increase in systemic mycoses. Tuberculosis (TB) with or without nocardiosis was a significant coinfection. Cyclosporine (CsA) was associated with nearly a 4-fold risk of systemic mycoses less than 6 months from the time of transplantation as compared with prednisolone+azathioprine (PRED+AZA) therapy. Overall, the probability of survival with systemic mycoses was 73.4%, 60.8%, 39.5%, and 25.6% and was 92.5%, 87.5%, 80.0%, and 75.5% without systemic mycoses at 1, 2, 5, and 10 years, respectively (P<0.0001). An extended Cox model with time-independent and dependent covariates showed greater than 15 times the risk of death among those who develop systemic mycoses. Similarly, Posttransplantation (postTX) TB±Nocardiosis, preTX TB, CMV disease, diabetes mellitus, PTDM, chronic liver disease (>40 months), and Pred+AZA immunosuppression (>2 years) had 3.5, 1.5, 2.9, 1.9, 1.4, 1.6, 2.3 times the risk for death, respectively, as compared with those who did not have those risk factors. Conclusions. There is a recent predominance of Aspergillus among the transplant recipients. The risk factors for systemic mycoses are CMV disease, chronic liver disease, and hyperglycemia, and TB is an important coinfection. Systemic mycoses increased in the early postTX period with CsA. The risk factors for death are systemic mycoses, CMV disease, chronic liver disease (>40 months), diabetes mellitus, and Pred+AZA immunosuppression (>2 years). Overall, the probability of survival with systemic mycoses was poor; however, survival has recently improved.

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