中国P站

Fungal infections; Solid organ transplantation; Invasive fungal disease; Immunosuppression; Epidemiology; Candida; Aspergillus; Antifungal prophylaxis; Transplant complications; Opportunistic infections

Introduction

Solid organ transplant (SOT) recipients are highly vulnerable to opportunistic infections due to prolonged immunosuppressive therapy, surgical complications, and disruption of anatomical barriers. Among these, fungal infections—particularly invasive fungal diseases (IFDs)—pose a major threat to morbidity and mortality in the post-transplant period [1-5]. While bacterial and viral infections are often well-characterized, fungal infections remain underdiagnosed and underreported, partly due to diagnostic limitations and delayed clinical recognition. Given the evolving landscape of immunosuppression, surgical practice, and antifungal prophylaxis, there is a pressing need to re-evaluate the epidemiological trends, risk factors, and outcomes associated with fungal infections in SOT recipients. This 10-year institutional review was conducted to analyze the incidence, timing, pathogen distribution, and mortality associated with fungal infections across different types of solid organ transplants at a high-volume tertiary care center [6-10].

Discussion

This retrospective study included 1,243 solid organ transplant recipients from 2012 to 2022, encompassing kidney (48%), liver (28%), heart (15%), and lung (9%) transplants. Fungal infections were documented in 162 patients (13%), with incidence varying significantly across organ types: lung transplant recipients had the highest incidence (29%), followed by liver (17%), heart (11%), and kidney (7%).

Candida species (58%) were the most common pathogens, primarily causing bloodstream infections and intra-abdominal candidiasis. Aspergillus species (31%), particularly A. fumigatus, were more frequently identified in lung transplant patients, often leading to invasive pulmonary aspergillosis. Rare infections caused by Cryptococcus, Fusarium, and Mucorales were also reported, especially in patients with prolonged neutropenia or recent rejection treatment.

The median time to fungal infection onset was 46 days post-transplant, with early infections (<30 days) mostly attributed to Candida, and late infections (>90 days) often involving molds like Aspergillus or Cryptococcus. Notably, recipients receiving antithymocyte globulin (ATG) or high-dose steroids for acute rejection had a significantly increased risk of IFD (p<0.001). Other risk factors included reoperation, renal replacement therapy, and CMV co-infection.

Fungal infections were associated with prolonged hospital stay (mean 29 days) and a 1-year mortality rate of 32%, compared to 14% in those without fungal infections. Invasive aspergillosis carried the highest mortality (42%), while Candida infections, though more frequent, had relatively better outcomes when promptly treated.

Improved outcomes were observed over time with the introduction of rapid diagnostic tools, multidisciplinary fungal infection teams, and protocolized antifungal stewardship, emphasizing the importance of early detection and individualized care.

Conclusion

Fungal infections remain a significant and often fatal complication in solid organ transplant recipients, with incidence and pathogen distribution varying by organ type. Candida and Aspergillus species continue to dominate the spectrum, though emerging fungi and resistant strains pose new clinical challenges. Early diagnosis, risk stratification, targeted prophylaxis, and timely antifungal treatment are critical to improving patient outcomes. This 10-year institutional review reinforces the need for integrated infection surveillance, advanced diagnostics, and personalized antifungal strategies in the care of immune compromised transplant recipients.

References

1. Khosravi N, Pishavar E, Baradaran B, Oroojalian F, Mokhtarzadeh A, et al. (2022) Stem cell membrane, stem cell-derived exosomes and hybrid stem cell camouflaged nanoparticles: A promising biomimetic nanoplatforms for cancer theranostics. J Control Release 348:706-722.

   Indexed at, Google Scholar, Crossref

2. Wu HH, Zhou Y, Tabata Y, Gao JQ (2019) Mesenchymal stem cell-based drug delivery strategy: from cells to biomimetic. J Control Release 28: 102-113.

   Indexed at, Google Scholar, Crossref

3. Yan K, Zhang J, Yin W, Harding JN, Ma F et al. (2022) Transcriptomic heterogeneity of cultured ADSCs corresponds to embolic risk in the host. IScience 4: 104822.

   Indexed at, Google Scholar, Crossref

4. Zhang W, Huang X (2022) Stem cell membrane-camouflaged targeted delivery system in tumor. Mater Today Bio 1: 100377.

   Indexed at, Google Scholar, Crossref

5. Li Y, Wu H, Jiang X, Dong Y, Zheng J, et al. (2022) New idea to promote the clinical applications of stem cells or their extracellular vesicles in central nervous system disorders: Combining with intranasal delivery. Acta Pharm Sin B 12: 3215-3232.

   Indexed at, Google Scholar, Crossref

6. Ji B, Cai H, Yang Y, Peng F, Song M, et al. (2020) Hybrid membrane camouflaged copper sulfide nanoparticles for photothermal-chemotherapy of hepatocellular carcinoma. Acta Biomater 111: 363-372.

   Indexed at, Google Scholar, Crossref

7. Wang M , Xin Y , Cao H , Li W , Hua Y, et al. (2021) Recent advances in mesenchymal stem cell membrane-coated nanoparticles for enhanced drug delivery. Biomater Sci 9:1088-1103.

   Indexed at, Google Scholar, Crossref

8. Xia Q, Zhang Y, Li Z, Hou X, Feng N, et al. (2019) Red blood cell membrane-camouflaged nanoparticles: a novel drug delivery system for antitumor application. Acta Pharm Sin B 9: 675-689.

   Indexed at, Google Scholar, Crossref

9. Shin MJ, Park JY, Lee DH, Khang D (2021) Stem Cell Mimicking Nanoencapsulation for Targeting Arthritis. Int J Nanomedicine 16: 8485-8507.

   Indexed at, Google Scholar, Crossref

10. Vasanthan V, Hassanabad AF, Fedak PWM (2021) Commentary: Cell therapy for spinal regeneration-implications for recovery after complex aortic surgery. JTCVS Open 24: 45-46.

    Indexed at, Google Scholar, Crossref