Mucormycosis after Living Donor Kidney Transplantation: A Multicenter Retrospective Study

Background and Aims: Mucormycosis is an extremely rare and potentially fatal complication after kidney transplantation. Limited data are available on mucormycosis following living donor kidney transplantation. The aim of this study was to determine the incidence of mucormycosis and to identify the clinical presentation and mortality rate in renal allograft recipients.

Methods: We conducted a retrospective survey of 7132 Iranian renal transplant recipients to find those with Mucormycosis in eight transplant centers from January 1990 to June 2008. A total of 22 patients had received kidneys from living donors were complicated with Mucormycosis. Mean follow up period after diagnosis was 9±13(1-60) months.

 Results: No significant differences were found between infection occurrence and gender (P=0.6). Patients with mucormycosis were older than those who had no infection (p=0.02) with the mean age at diagnosis 48 ± 13 years. The diagnosis time since transplantation ranged from 1-84 (Median: 12) months. Mucormycosis was most likely to occur within 1 year after renal transplantation (n=13). The major form of disease in population studied was rhino-cerebral (n =11), followed by pulmonary (n=8), cutaneous (n=2), and disseminated (n=1). In addition, 9 patients have had the history of steroid pulse therapy. Diabetes mellitus was seen in 6 recipients with mucormycosis.

Conclusions: To our knowledge, the current study is the largest sample of renal recipients with ormycosis in living donor renal transplantation. Augmented immunosuppression, especially with corticosteroids, older age and PTDM were the predisposing factors for the infection.