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. 2025 Aug;25(8):1775-1783.
doi: 10.1016/j.ajt.2025.03.030. Epub 2025 Apr 3.

Longitudinal assessment of the effect of invasive fungal infections on transplant success in kidney transplant recipients

Lucy X Li  1 , Jiashu Xue  2 , Teresa Po-Yu Chiang  3 , Na Lu  2 , Darin Ostrander  2 , Sean X Zhang  4 , John W Baddley  2 , Shmuel Shoham  2 , Daniel C Brennan  2 , Christine M Durand  2 , William A Werbel  2 , Kieren A Marr  5 , Robin K Avery  2 , Nitipong Permpalung  6
Affiliations

Longitudinal assessment of the effect of invasive fungal infections on transplant success in kidney transplant recipients

Lucy X Li et al. Am J Transplant. 2025 Aug.

Abstract

Invasive fungal infections (IFIs) significantly impact morbidity and mortality in kidney transplant recipients (KTRs), but their effect on allograft function remains poorly defined. This retrospective study examined adult KTRs transplanted at Johns Hopkins from 2012 to 2018, with follow-up through 2023. The association of IFIs with a composite outcome of graft failure and mortality was assessed using negative binomial regression. The association of IFI exposure on composite outcome was quantified by matching using a stochastic extension stratification method, followed by Cox regression. Among 1453 KTRs, 79 were diagnosed with proven/probable IFIs, predominantly invasive candidiasis (46.8%). KTRs with IFIs had worse outcome-free survival with higher composite outcome rates (53/79 [67.1%] vs 411/1338 [30.7%]; P < .001). The composite outcome incidence rate was 4.61-fold higher when IFIs occurred in the first 6 months posttransplant and decreased to 2.13-fold higher after 36 months (P < .001). IFI exposure was associated with 3.45-fold increased hazard of composite outcome (95% CI, 1.54-7.70; P < .01) and a 3.23-fold increased hazard of all-cause mortality (95% CI, 1.53-6.83; P < .01). The association of IFIs with increased risk of poor kidney transplant outcomes, particularly in the early posttransplant period, highlights the need for improved strategies for early IFI detection and management in KTRs.

Keywords: invasive fungal infection; kidney allograft function; kidney transplantation.

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Conflict of interest statement

Declaration of competing interest The authors of this manuscript have conflicts of interest to disclose as described by American Journal of Transplantation. S.X. Zhang is partially supported by funding from IMMY Diagnostics, Vela Diagnostics, Applied BioCode, T2 Biosystems, Pearl Diagnostics, and Scanogen; board membership in Pearl Diagnostics and T2 Biosystems; and consulting or advisory fees from Pearl Diagnostics, T2 Biosystems and Karius. J.W. Baddley was a consultant for Pfizer. S. Shoham receives funding from F2G, Cidara, Ansun, and Zeteo; consults for Celtrion, Adagio, Immunome, Scynexis, Karius, and Pfizer; and has stock options with Immunome; and has also served on the Board of Governors of the American College of Physicians. C.M. Durand received payments from Gilead for grant reviewing and conducts research studies with drug donated by Gilead. W.A. Werbel has received consulting and/or speaking fees from AstraZeneca, GlobalData, China Medical Tribune, and Medical Learning Institute (CME) and advisory board fees from AstraZeneca and Novavax. K.A. Marr discloses employment and equity in Elion Therapeutics and equity and royalty income from Pearl Diagnostics. R.K. Avery receives funding from Aicuris Anti-infective Cures, Astellas, Astra-zeneca, Chimerix, Merck, Oxford Immunotec, Qiagen, Regeneron, and Takeda. N. Permpalung consults for Shionogi, Pulmocide, Clearview HealthCare Partners, and Alcimed and receives study grant support from Caredx, IMMY Diagnostics, and Merck.

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