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. 2023 Sep;37(9):e15038.
doi: 10.1111/ctr.15038. Epub 2023 May 25.

Candidemia in thoracic solid organ transplant recipients: Characteristics and outcomes relative to matched uninfected and bacteremic thoracic organ transplant recipients

Emily M Eichenberger  1 , Sarah Satola  1 , David Neujahr  2 , Vance G Fowler Jr  3 , Divya Gupta  4 , Mandy Ford  5 , Stephanie M Pouch  1
Affiliations

Candidemia in thoracic solid organ transplant recipients: Characteristics and outcomes relative to matched uninfected and bacteremic thoracic organ transplant recipients

Emily M Eichenberger et al. Clin Transplant. 2023 Sep.

Abstract

Background: Little is understood about the risk factors and outcomes from candidemia in thoracic solid organ transplant recipients.

Methods: This is a single-center retrospective cohort study of patients undergoing heart or lung transplant between January 1, 2013 and December 31, 2022. We performed two comparisons among heart and lung transplant recipients: (1) recipients with candidemia versus matched, uninfected recipients, and (2) recipients with candidemia versus recipients with bacteremia.

Results: During the study 384 heart and 194 lung transplants were performed. Twenty-one (5.5%) heart and six (3.1%) lung recipients developed candidemia. Heart recipients with candidemia were more likely to have had delayed chest closure (38.1% vs. 0%, p < .0001), temporary mechanical circulatory support (57.1% vs. 11.9%, p = .0003), and repeat surgical chest exploration 76.2% vs. 16.7%, p < .0001) than uninfected controls. Heart and lung recipients who developed candidemia were more likely to have been on renal replacement therapy prior to infection relative to uninfected controls (57.1% vs. 11.9%, p = .0003 and 66.7% vs. 0%, p = .0041, respectively). Heart recipients with candidemia had significantly lower post-transplant survival and lower post-infection survival relative to matched uninfected controls and heart recipients with bacteremia, respectively (p < .0001 and p = .0002, respectively).

Conclusions: Candidemia following heart and lung transplantation is associated with significant morbidity and mortality. Further research is needed to understand if heart recipients with delayed chest closure, temporary mechanical circulatory support, renal replacement therapy, and repeat surgical chest exploration may benefit from targeted antifungal prophylaxis.

Keywords: bacteremia; candidemia; outcomes; thoracic solid organ transplant.

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Figures

Figure 1:
Figure 1:
Microbial epidemiology of bloodstream infection. A) Candidemia in heart and lung transplant recipients; B) Bacteremia in heart and lung transplant recipients.
Figure 1:
Figure 1:
Microbial epidemiology of bloodstream infection. A) Candidemia in heart and lung transplant recipients; B) Bacteremia in heart and lung transplant recipients.
Figure 2:
Figure 2:
A) Time to bloodstream infection for A) Heart transplant recipients and b) Lung transplant recipients.
Figure 2:
Figure 2:
A) Time to bloodstream infection for A) Heart transplant recipients and b) Lung transplant recipients.
Figure 3:
Figure 3:
A) Post-infection survival of heart recipients with candidemia vs bacteremia. B) Post-infection survival of lung recipients with candidemia vs bacteremia.
Figure 3:
Figure 3:
A) Post-infection survival of heart recipients with candidemia vs bacteremia. B) Post-infection survival of lung recipients with candidemia vs bacteremia.
See this image and copyright information in PMC

References

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