TY - JOUR
T1 - Outcomes after lung resection in renal transplant patients with pulmonary mucormycosis
AU - Seth, Abhinav
AU - Patil, Shivakumar S.
AU - Axelrod, David
AU - Singh, Harkant
AU - Sharma, Ashish
AU - Kenwar, Deepesh Benjamin
AU - Vaiphei, Kim
AU - Mandwar, Milind
AU - Rally, Sahil
AU - Singh, Sarbpreet
N1 - Publisher Copyright:
© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
PY - 2022/7
Y1 - 2022/7
N2 - Background: Pulmonary mucormycosis has been associated with high mortality (reported up to 100%) in renal transplant recipients. Methods: This was a retrospective analysis of renal transplant patients with pulmonary mucormycosis between April 2014 and March 2020, who underwent surgical resection of the affected lung along with liposomal amphotericin therapy. Patients with lower respiratory illness features underwent chest X-ray, high-resolution computed tomography of the chest, and those with suspicious findings underwent analysis of bronchioloalveolar fluid and transbronchial lung biopsy. Patients with histological or microbiological evidence of mucormycosis were started on liposomal Amphotericin B. Tacrolimus and mycophenolate mofetil were stopped at the time of diagnosis. Result: Ten patients underwent combined management, while five patients were managed medically. At last follow up, seven out of ten patients (70%) who underwent combined management and two of the five patients (40%) who were managed medically, had a mean survival of 28.86 months (sd = 15.71, median = 25) and 14.17 months (sd = 12.21, median = 18), respectively, post-diagnosis of pulmonary mucormycosis. Conclusion: Surgical resection combined with antifungals in the perioperative period and decreased immunosuppression may improve the outcomes in renal transplant patients with pulmonary mucormycosis.
AB - Background: Pulmonary mucormycosis has been associated with high mortality (reported up to 100%) in renal transplant recipients. Methods: This was a retrospective analysis of renal transplant patients with pulmonary mucormycosis between April 2014 and March 2020, who underwent surgical resection of the affected lung along with liposomal amphotericin therapy. Patients with lower respiratory illness features underwent chest X-ray, high-resolution computed tomography of the chest, and those with suspicious findings underwent analysis of bronchioloalveolar fluid and transbronchial lung biopsy. Patients with histological or microbiological evidence of mucormycosis were started on liposomal Amphotericin B. Tacrolimus and mycophenolate mofetil were stopped at the time of diagnosis. Result: Ten patients underwent combined management, while five patients were managed medically. At last follow up, seven out of ten patients (70%) who underwent combined management and two of the five patients (40%) who were managed medically, had a mean survival of 28.86 months (sd = 15.71, median = 25) and 14.17 months (sd = 12.21, median = 18), respectively, post-diagnosis of pulmonary mucormycosis. Conclusion: Surgical resection combined with antifungals in the perioperative period and decreased immunosuppression may improve the outcomes in renal transplant patients with pulmonary mucormycosis.
KW - amphotericin
KW - graft and patient survival outcomes
KW - pulmonary mucormycosis
KW - renal transplant patients
KW - surgical resection
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U2 - 10.1111/ctr.14689
DO - 10.1111/ctr.14689
M3 - Article
C2 - 35477936
AN - SCOPUS:85129541836
VL - 36
JO - Clinical Transplantation
JF - Clinical Transplantation
SN - 0902-0063
IS - 7
M1 - e14689
ER -