D167 - Management of Disseminated Fungal Disease in Renal Transplant Recipients: A Case Series

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Author Block: H. Soliman¹, R. S. Raman², M. A. Alfaqih², P. Singh³, R. Shahbazov², ¹Surgery, Albany Medical College, Albany, NY, ²Surgery, Albany Medical Center, Albany, NY, ³Medicine, Albany Medical Center, Albany, NY
*Purpose: This case series aims to describe the clinical course, management, and outcomes of two renal transplant recipients who developed severe disseminated fungal infections, one with invasive aspergillosis (IA) and one with mucormycosis, highlighting differences in timing, pathogen behavior, and treatment response.
*Methods: We retrospectively reviewed two cases who developed severe disseminated fungal infections post deceased donor kidney transplant (DDKT) at our institution.
*Results: Patient 1, a 67-year-old male one-year post-transplant, developed disseminated IA with pulmonary nodules and a central nerve system (CNS) fungal abscess. ( Picture 1).He required ventilatory and hemodynamic support but stabilized under aggressive therapy with amphotericin B, micafungin, and voriconazole while immunosuppression was held. Renal graft function remained preserved, and he was discharged on hospital day 72. Patient 2, a 59-year-old male 10 days post-transplant, developed mucormycosis presenting with multifocal pulmonary infiltrates. Despite early initiation of isavuconazole followed by amphotericin B and intensive supportive care, he deteriorated and died on hospital day 45.
*Conclusions: Disseminated fungal infections in renal transplant recipients present significant diagnostic and therapeutic challenges. IA may manifest later post-transplant with potential for recovery under aggressive therapy, while mucormycosis can occur early and progress rapidly, often resulting in poor outcomes despite prompt treatment. These cases underscore the importance of early recognition, rapid antifungal therapy, multidisciplinary management, and careful balancing of immunosuppression to optimize survival and graft function in this high-risk population