Risk Factors Associated With Invasive Fungal Infections in Kidney Transplant Patients

Am J Med Sci. 2020 Feb;359(2):108-116. doi: 10.1016/j.amjms.2019.10.008. Epub 2019 Oct 24.


Background: Kidney transplant recipients are at increased risk for developing invasive fungal infections (IFI). We queried the United States Renal Data System (USRDS) for risk factors for IFI in these patients.

Methods: Patients who underwent a kidney transplant between 2005 and 2008 were queried for an IFI diagnosis using ICD-9 codes. An IFI was defined as at least one documented diagnosis from one of the following: (1) Candida (candidemia); (2) Histoplasmosis; (3) Aspergillosis; (4) Cryptococcosis; (5) "Other" mycoses. Potential risk factors included demographics, certain comorbidities and immunosuppressive medications. To examine the relative risk (RR), simple bivariate models were used, followed by a comprehensive full model to estimate the adjusted RR (aRR).

Results: Of 57,188 kidney transplant patients, 1,218 had 1,343 IFI diagnoses, with a median time to infection of 495 days. "Other" mycoses accounted for the most IFI diagnoses (37%), followed by aspergillosis (22%). The risk for any IFI was increased with age ≥65 years. Diabetes (aRR = 1.71), bacterial pneumonia (aRR = 1.62) and UTI (aRR = 1.34) were the top 3 clinical risk factors for infection. Each of the IFI groups was also associated with individual risk factors. Therapy with mycophenolate mofetil was associated with a decreased risk of candidemia.

Conclusions: Risk factors for IFI in renal transplant patients include demographic, medication-associated and clinical data, as well as organism-specific factors. These results offer an extensive clinical profile of risk for IFI, and may thus help inform the diagnosis and presumptive therapy of invasive fungal infections in renal transplant recipients.

Keywords: Infections; Invasive fungal infection; Kidney transplantation; Risk factors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Aspergillosis / chemically induced
  • Aspergillosis / diagnosis
  • Aspergillosis / drug therapy
  • Aspergillosis / epidemiology*
  • Female
  • Humans
  • Immunosuppressive Agents / administration & dosage
  • Immunosuppressive Agents / adverse effects
  • Invasive Fungal Infections / chemically induced
  • Invasive Fungal Infections / diagnosis
  • Invasive Fungal Infections / drug therapy
  • Invasive Fungal Infections / epidemiology*
  • Kidney Transplantation*
  • Male
  • Middle Aged
  • Models, Biological*
  • Risk Factors


  • Immunosuppressive Agents