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.