Invasive fungal infection in renal transplant recipients demonstrated by panfungal polymerase chain reaction

Abstract

Objectives: Invasive fungal infections following renal transplant are associated with high morbidity and mortality rates. This study reports our experience using molecular assay to diagnose invasive fungal infections in renal graft recipients.

Patients and methods: One hundred twenty patients who had undergone renal transplant at the Organ Transplant Unit of Nemazi Hospital in Shiraz, Iran, between September 2004 and January 2006 were followed up for fungal infections for 6 months following transplant. Blood samples were cultured by bedside inoculation to BACTEC fungal medium. Whole blood specimens were collected prospectively once per week and were evaluated for any invasive fungal infections using panfungal polymerase chain reaction and polymerase chain reaction-enzyme-linked immunosorbent assay. The female-to-male ratio was 44.2% to 55.8%, the mean age of the recipients was 34.7 years, and the mean length of hospitalization was 10.92 days.

Results: The sensitivity and specificity for proven and probable infections were 80% and 95.6%, respectively. Using panfungal polymerase chain reaction- enzyme-linked immunosorbent assay, 4 recipients were diagnosed as having invasive fungal infections. The etiologic agents were C. albicans in 3 patients, and C. albicans and A. fumigatus in 1 patient. The mean interval of polymerase chain reaction-enzyme-linked immunosorbent assay positivity in blood samples before clinical signs was 27 days (range, 7-60 days).

Conclusions: Polymerase chain reaction-enzyme-linked immunosorbent assay may improve early diagnosis of invasive fungal infections; however, correlating the results of polymerase chain reaction-enzyme-linked immunosorbent assay with clinical outcomes in renal transplant recipients will require further evaluation.